|
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
|
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
|
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
|
$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
|
|
|
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
|
Facility
|
OP
|
$1,141.64
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
4502360501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.63 |
| Max. Negotiated Rate |
$1,084.56 |
| Rate for Payer: Aetna of VT Commercial |
$1,084.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,022.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,022.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$970.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$513.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$907.60
|
| Rate for Payer: Cash Price |
$570.82
|
| Rate for Payer: Cigna Commercial |
$913.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$913.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$913.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.74
|
| Rate for Payer: Multiplan Commercial |
$1,061.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.74
|
| Rate for Payer: United Healthcare Commercial |
$1,084.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.74
|
| Rate for Payer: United Healthcare VA CCN |
$513.74
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
5102450501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$498.09 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Aetna of VT Commercial |
$639.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$565.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$538.40
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$538.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.40
|
| Rate for Payer: Multiplan Commercial |
$625.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.05
|
| Rate for Payer: United Healthcare Commercial |
$639.35
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9602457601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.59 |
| Max. Negotiated Rate |
$1,397.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,397.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,332.20
|
| 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 |
$1,332.20
|
| 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 |
$743.50
|
| Rate for Payer: Cash Price |
$743.50
|
| 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 |
$1,382.91
|
| 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
|
$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
|
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
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
9812457602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$378.24 |
| 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 |
$765.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$378.24
|
| 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 |
$514.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$725.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$691.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$384.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.93
|
| 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: Martins Point Health Care Commercial |
$384.30
|
| Rate for Payer: Multiplan Commercial |
$794.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$725.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.30
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.30
|
| Rate for Payer: United Healthcare VA CCN |
$384.30
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
5102456001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of VT Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$524.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.16
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.60
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare VA CCN |
$291.60
|
|
|
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
|
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
|
OP
|
$2,018.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
9602450501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$893.77 |
| 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 |
$1,807.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$893.77
|
| 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 |
$1,214.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,715.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,634.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$908.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,604.31
|
| 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: Martins Point Health Care Commercial |
$908.10
|
| Rate for Payer: Multiplan Commercial |
$1,876.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,715.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$908.10
|
| Rate for Payer: United Healthcare Commercial |
$1,917.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$908.10
|
| Rate for Payer: United Healthcare VA CCN |
$908.10
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
9812456002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$236.09 |
| 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 |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.20
|
| 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: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$759.47
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
4502450001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.37 |
| Max. Negotiated Rate |
$721.50 |
| Rate for Payer: Aetna of VT Commercial |
$721.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$680.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$336.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$680.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$645.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$615.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$603.78
|
| Rate for Payer: Cash Price |
$379.74
|
| Rate for Payer: Cigna Commercial |
$607.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$607.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$607.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$341.76
|
| Rate for Payer: Multiplan Commercial |
$706.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$645.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$341.76
|
| Rate for Payer: United Healthcare Commercial |
$721.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.76
|
| Rate for Payer: United Healthcare VA CCN |
$341.76
|
|
|
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
|
|
|
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
|
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
|
$874.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$387.09 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Aetna of VT Commercial |
$830.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$387.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$526.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$742.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$694.83
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$699.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.30
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.30
|
| Rate for Payer: United Healthcare Commercial |
$830.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.30
|
| Rate for Payer: United Healthcare VA CCN |
$393.30
|
|
|
TREAT KNEECAP DISLOCATION
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$821.56 |
| Rate for Payer: Aetna of VT Commercial |
$821.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$783.02
|
| 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 |
$783.02
|
| 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 |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| 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 |
$812.82
|
| 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
|
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
|
$486.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
9812756202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$359.69 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of VT Commercial |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.80
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$451.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
