|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
9815422002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$815.59 |
| Max. Negotiated Rate |
$1,046.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,046.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$815.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$815.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$936.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$925.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$881.60
|
| Rate for Payer: Cash Price |
$551.00
|
| Rate for Payer: Cigna Commercial |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$881.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$881.60
|
| Rate for Payer: Multiplan Commercial |
$1,024.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$936.70
|
| Rate for Payer: United Healthcare Commercial |
$1,046.90
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$3,477.00
|
|
|
Service Code
|
CPT 27507
|
| Hospital Charge Code |
9822750701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,573.33 |
| Max. Negotiated Rate |
$3,303.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,303.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,573.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,573.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,955.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,920.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,781.60
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$2,781.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,781.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,781.60
|
| Rate for Payer: Multiplan Commercial |
$3,233.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,955.45
|
| Rate for Payer: United Healthcare Commercial |
$3,303.15
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$3,422.00
|
|
|
Service Code
|
CPT 27511
|
| Hospital Charge Code |
9822751101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,515.60 |
| Max. Negotiated Rate |
$3,250.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,250.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,065.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,515.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,065.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,060.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,908.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,771.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,539.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,720.49
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,737.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,539.90
|
| Rate for Payer: Multiplan Commercial |
$3,182.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,908.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,539.90
|
| Rate for Payer: United Healthcare Commercial |
$3,250.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,539.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,539.90
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750201
|
|
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
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750201
|
|
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
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
9822750601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,249.30 |
| Max. Negotiated Rate |
$3,961.16 |
| Rate for Payer: Aetna of VT Commercial |
$3,961.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,775.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,286.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,775.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,749.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,847.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,847.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,436.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,847.02
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$2,366.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,091.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,091.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,249.30
|
| Rate for Payer: Multiplan Commercial |
$3,919.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,774.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,249.30
|
| Rate for Payer: United Healthcare Commercial |
$1,921.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,249.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,249.30
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$2,336.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9822751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,034.61 |
| Max. Negotiated Rate |
$2,219.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,034.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,892.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,857.12
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,868.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,985.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,051.20
|
| Rate for Payer: United Healthcare Commercial |
$2,219.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,051.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,051.20
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$2,336.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9822751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$640.88 |
| Max. Negotiated Rate |
$2,195.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,195.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$660.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$897.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,002.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$737.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,002.04
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,219.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,072.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,072.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$640.88
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$640.89
|
| Rate for Payer: United Healthcare Commercial |
$985.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$640.89
|
| Rate for Payer: United Healthcare VA CCN |
$640.89
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$1,463.65
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
4502751001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.25 |
| Max. Negotiated Rate |
$1,390.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,311.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$648.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,311.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$881.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,244.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,185.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$658.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,163.60
|
| Rate for Payer: Cash Price |
$731.82
|
| Rate for Payer: Cigna Commercial |
$1,170.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,170.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,170.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$658.64
|
| Rate for Payer: Multiplan Commercial |
$1,361.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,244.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$658.64
|
| Rate for Payer: United Healthcare Commercial |
$1,390.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$658.64
|
| Rate for Payer: United Healthcare VA CCN |
$658.64
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,958.27
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
4502750201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,189.42 |
| Max. Negotiated Rate |
$2,810.36 |
| Rate for Payer: Aetna of VT Commercial |
$2,810.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,189.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,189.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,514.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,484.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,366.62
|
| Rate for Payer: Cash Price |
$1,479.13
|
| Rate for Payer: Cigna Commercial |
$2,366.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,366.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,366.62
|
| Rate for Payer: Multiplan Commercial |
$2,751.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,514.53
|
| Rate for Payer: United Healthcare Commercial |
$2,810.36
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$2,958.27
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
4502750201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,310.22 |
| Max. Negotiated Rate |
$2,810.36 |
| Rate for Payer: Aetna of VT Commercial |
$2,810.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,650.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,310.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,650.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,780.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,514.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,396.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,331.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,351.82
|
| Rate for Payer: Cash Price |
$1,479.13
|
| Rate for Payer: Cigna Commercial |
$2,366.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,366.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,366.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,331.22
|
| Rate for Payer: Multiplan Commercial |
$2,751.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,514.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,331.22
|
| Rate for Payer: United Healthcare Commercial |
$2,810.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,331.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,331.22
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,927.22 |
| Max. Negotiated Rate |
$2,473.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,927.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,927.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,213.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,187.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,083.20
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$2,083.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,083.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,083.20
|
| Rate for Payer: Multiplan Commercial |
$2,421.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,213.40
|
| Rate for Payer: United Healthcare Commercial |
$2,473.80
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,153.31 |
| Max. Negotiated Rate |
$2,473.80 |
| Rate for Payer: Aetna of VT Commercial |
$2,473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,332.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,153.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,332.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,567.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,213.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,109.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,171.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,070.18
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$2,083.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,083.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,083.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,171.80
|
| Rate for Payer: Multiplan Commercial |
$2,421.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,213.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,171.80
|
| Rate for Payer: United Healthcare Commercial |
$2,473.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,171.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,171.80
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$2,604.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$706.50 |
| Max. Negotiated Rate |
$2,447.76 |
| Rate for Payer: Aetna of VT Commercial |
$2,447.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,332.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$727.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,332.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$989.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,391.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,391.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$812.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,391.71
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,184.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,184.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.50
|
| Rate for Payer: Multiplan Commercial |
$2,421.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.50
|
| Rate for Payer: United Healthcare Commercial |
$1,086.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.50
|
| Rate for Payer: United Healthcare VA CCN |
$706.50
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9812751002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,728.87 |
| Max. Negotiated Rate |
$2,219.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,962.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,868.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,985.60
|
| Rate for Payer: United Healthcare Commercial |
$2,219.20
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$1,463.65
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
4502751001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,083.25 |
| Max. Negotiated Rate |
$1,390.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,083.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,083.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,244.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,229.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,170.92
|
| Rate for Payer: Cash Price |
$731.82
|
| Rate for Payer: Cigna Commercial |
$1,170.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,170.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,170.92
|
| Rate for Payer: Multiplan Commercial |
$1,361.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,244.10
|
| Rate for Payer: United Healthcare Commercial |
$1,390.47
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
9812750201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1,391.71 |
| 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 |
$727.70
|
| 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 |
$989.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,391.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,391.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$812.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,391.71
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,184.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,184.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.50
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$706.50
|
| Rate for Payer: United Healthcare Commercial |
$1,086.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$706.50
|
| Rate for Payer: United Healthcare VA CCN |
$706.50
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
9822750601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,118.78 |
| Max. Negotiated Rate |
$4,003.30 |
| Rate for Payer: Aetna of VT Commercial |
$4,003.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,118.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,118.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,581.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,539.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,371.20
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,371.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,371.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,371.20
|
| Rate for Payer: Multiplan Commercial |
$3,919.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,581.90
|
| Rate for Payer: United Healthcare Commercial |
$4,003.30
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$3,477.00
|
|
|
Service Code
|
CPT 27507
|
| Hospital Charge Code |
9822750701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,539.96 |
| Max. Negotiated Rate |
$3,303.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,303.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,115.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,539.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,115.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,093.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,955.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,816.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,564.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,764.22
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$2,781.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,781.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,781.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,564.65
|
| Rate for Payer: Multiplan Commercial |
$3,233.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,955.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,564.65
|
| Rate for Payer: United Healthcare Commercial |
$3,303.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,564.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,564.65
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9812751001
|
|
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
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,336.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9822751001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,728.87 |
| Max. Negotiated Rate |
$2,219.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,219.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,985.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,962.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,868.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,868.80
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,985.60
|
| Rate for Payer: United Healthcare Commercial |
$2,219.20
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$2,336.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
9812751002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$640.88 |
| Max. Negotiated Rate |
$2,195.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,195.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$660.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,092.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$897.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,002.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$737.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,002.04
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cigna Commercial |
$1,219.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,072.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,072.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$640.88
|
| Rate for Payer: Multiplan Commercial |
$2,172.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$640.89
|
| Rate for Payer: United Healthcare Commercial |
$985.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$640.89
|
| Rate for Payer: United Healthcare VA CCN |
$640.89
|
|
|
TREATMENT OF THIGH FRACTURE
|
Professional
|
Both
|
$3,422.00
|
|
|
Service Code
|
CPT 27511
|
| Hospital Charge Code |
9822751101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$925.62 |
| Max. Negotiated Rate |
$3,216.68 |
| Rate for Payer: Aetna of VT Commercial |
$3,216.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,065.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$953.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,065.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,295.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,534.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,534.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,064.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,534.13
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$1,756.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,551.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,551.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$925.62
|
| Rate for Payer: Multiplan Commercial |
$3,182.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,314.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$925.62
|
| Rate for Payer: United Healthcare Commercial |
$1,423.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$925.62
|
| Rate for Payer: United Healthcare VA CCN |
$925.62
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
9822750601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,866.38 |
| Max. Negotiated Rate |
$4,003.30 |
| Rate for Payer: Aetna of VT Commercial |
$4,003.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,775.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,866.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,775.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,536.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,581.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,413.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,896.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,350.13
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,371.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,371.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,371.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,896.30
|
| Rate for Payer: Multiplan Commercial |
$3,919.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,581.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,896.30
|
| Rate for Payer: United Healthcare Commercial |
$4,003.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,896.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,896.30
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
CPT 27511
|
| Hospital Charge Code |
9822751101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,532.62 |
| Max. Negotiated Rate |
$3,250.90 |
| Rate for Payer: Aetna of VT Commercial |
$3,250.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,532.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,532.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,908.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,874.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,737.60
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cigna Commercial |
$2,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,737.60
|
| Rate for Payer: Multiplan Commercial |
$3,182.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,908.70
|
| Rate for Payer: United Healthcare Commercial |
$3,250.90
|
|
