|
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
|
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
|
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
|
|
|
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 TIBIA FRACTURE
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9812775201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$938.45 |
| Max. Negotiated Rate |
$1,204.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,204.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$938.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$938.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,077.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,065.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,014.40
|
| Rate for Payer: Cash Price |
$634.00
|
| Rate for Payer: Cigna Commercial |
$1,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,014.40
|
| Rate for Payer: Multiplan Commercial |
$1,179.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,077.80
|
| Rate for Payer: United Healthcare Commercial |
$1,204.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$1,884.98
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
4502775201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,395.07 |
| Max. Negotiated Rate |
$1,790.73 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,395.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,602.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,583.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,507.98
|
| Rate for Payer: Cash Price |
$942.49
|
| Rate for Payer: Cigna Commercial |
$1,507.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,507.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,507.98
|
| Rate for Payer: Multiplan Commercial |
$1,753.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,602.23
|
| Rate for Payer: United Healthcare Commercial |
$1,790.73
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$2,512.00
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
9822775901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$934.54 |
| Max. Negotiated Rate |
$2,361.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,361.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$962.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,250.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,308.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,490.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,074.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,490.10
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$1,769.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,562.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,562.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$934.54
|
| Rate for Payer: Multiplan Commercial |
$2,336.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,327.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$934.54
|
| Rate for Payer: United Healthcare Commercial |
$1,437.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$934.54
|
| Rate for Payer: United Healthcare VA CCN |
$934.54
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9812775202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$729.90 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$729.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$992.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,334.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,310.16
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$741.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,400.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare Commercial |
$1,565.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare VA CCN |
$741.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$1,884.98
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
4502775201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$834.86 |
| Max. Negotiated Rate |
$1,790.73 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,688.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$834.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,688.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,134.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,602.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,526.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$848.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,498.56
|
| Rate for Payer: Cash Price |
$942.49
|
| Rate for Payer: Cigna Commercial |
$1,507.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,507.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,507.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$848.24
|
| Rate for Payer: Multiplan Commercial |
$1,753.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,602.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$848.24
|
| Rate for Payer: United Healthcare Commercial |
$1,790.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$848.24
|
| Rate for Payer: United Healthcare VA CCN |
$848.24
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$1,885.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
5102775201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,395.09 |
| Max. Negotiated Rate |
$1,790.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,395.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,602.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,583.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,508.00
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cigna Commercial |
$1,508.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,508.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,508.00
|
| Rate for Payer: Multiplan Commercial |
$1,753.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,602.25
|
| Rate for Payer: United Healthcare Commercial |
$1,790.75
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$3,533.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,614.77 |
| Max. Negotiated Rate |
$3,356.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,356.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,614.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,614.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,003.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,967.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,826.40
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$2,826.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,826.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,826.40
|
| Rate for Payer: Multiplan Commercial |
$3,285.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,003.05
|
| Rate for Payer: United Healthcare Commercial |
$3,356.35
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$1,549.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,549.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$484.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$658.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$540.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.58
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$891.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.71
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$667.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare VA CCN |
$470.13
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$3,533.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$3,321.02 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,165.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$484.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,165.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$658.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$540.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.58
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$891.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.71
|
| Rate for Payer: Multiplan Commercial |
$3,285.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$667.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare VA CCN |
$470.13
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
9822775801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,300.35 |
| Max. Negotiated Rate |
$2,789.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,789.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,300.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,767.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,495.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,378.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,334.12
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cigna Commercial |
$2,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,348.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,348.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,321.20
|
| Rate for Payer: Multiplan Commercial |
$2,730.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,495.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,321.20
|
| Rate for Payer: United Healthcare Commercial |
$2,789.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,321.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,321.20
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9822775201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,219.68 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,219.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,219.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,384.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,318.40
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.40
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,400.80
|
| Rate for Payer: United Healthcare Commercial |
$1,565.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$3,533.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,564.77 |
| Max. Negotiated Rate |
$3,356.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,356.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,165.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,564.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,165.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,126.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,003.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,861.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,589.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,808.74
|
| Rate for Payer: Cash Price |
$1,766.50
|
| Rate for Payer: Cigna Commercial |
$2,826.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,826.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,826.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,589.85
|
| Rate for Payer: Multiplan Commercial |
$3,285.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,003.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,589.85
|
| Rate for Payer: United Healthcare Commercial |
$3,356.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,589.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,589.85
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,219.68 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,219.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,219.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,384.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,318.40
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.40
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,400.80
|
| Rate for Payer: United Healthcare Commercial |
$1,565.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$1,885.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
5102775201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$834.87 |
| Max. Negotiated Rate |
$1,790.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,688.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$834.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,688.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,134.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,602.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,526.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$848.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,498.58
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cigna Commercial |
$1,508.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,508.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,508.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$848.25
|
| Rate for Payer: Multiplan Commercial |
$1,753.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,602.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$848.25
|
| Rate for Payer: United Healthcare Commercial |
$1,790.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$848.25
|
| Rate for Payer: United Healthcare VA CCN |
$848.25
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
9822775801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$2,759.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,759.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$869.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,630.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,181.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,555.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,555.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$970.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,555.49
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cash Price |
$1,468.00
|
| Rate for Payer: Cigna Commercial |
$1,598.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,408.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,408.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$843.72
|
| Rate for Payer: Multiplan Commercial |
$2,730.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,198.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$843.72
|
| Rate for Payer: United Healthcare Commercial |
$1,297.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$843.72
|
| Rate for Payer: United Healthcare VA CCN |
$843.72
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9602775202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$729.90 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$729.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$992.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,334.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,310.16
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$741.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,400.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare Commercial |
$1,565.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare VA CCN |
$741.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9822775201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$729.90 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,565.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$729.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$992.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,334.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,310.16
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,318.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$741.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,400.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare Commercial |
$1,565.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$741.60
|
| Rate for Payer: United Healthcare VA CCN |
$741.60
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9812775202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$1,549.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,549.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$484.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$658.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$540.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.58
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$891.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.71
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$667.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare VA CCN |
$470.13
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$1,885.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
5102775201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$1,771.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,771.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,688.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$484.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,688.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$658.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$540.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.58
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cigna Commercial |
$891.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.71
|
| Rate for Payer: Multiplan Commercial |
$1,753.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$667.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare VA CCN |
$470.13
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
9822775901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,859.13 |
| Max. Negotiated Rate |
$2,386.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,386.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,859.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,859.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,135.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,110.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,009.60
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cigna Commercial |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,009.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,009.60
|
| Rate for Payer: Multiplan Commercial |
$2,336.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,135.20
|
| Rate for Payer: United Healthcare Commercial |
$2,386.40
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9822775201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$1,549.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,549.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$484.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,476.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$658.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$803.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$540.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.58
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cigna Commercial |
$891.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$516.71
|
| Rate for Payer: Multiplan Commercial |
$1,532.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$667.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare Commercial |
$723.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare VA CCN |
$470.13
|
|
