|
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
|
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
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
9822775801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,172.93 |
| 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 |
$2,172.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,172.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,495.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,466.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,348.80
|
| 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: Multiplan Commercial |
$2,730.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,495.60
|
| Rate for Payer: United Healthcare Commercial |
$2,789.20
|
|
|
TREATMENT OF TIBIA FRACTURE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
9812775201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$1,191.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,136.00
|
| 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 |
$1,136.00
|
| 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 |
$634.00
|
| Rate for Payer: Cash Price |
$634.00
|
| 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 |
$1,179.24
|
| 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
|
$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 TOE FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851001
|
|
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 TOE FRACTURE
|
Facility
|
OP
|
$220.80
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
4502851001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna of VT Commercial |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.54
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$205.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.36
|
| Rate for Payer: United Healthcare Commercial |
$209.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.36
|
| Rate for Payer: United Healthcare VA CCN |
$99.36
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5102851501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of VT Commercial |
$197.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.36
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$193.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.60
|
| Rate for Payer: United Healthcare Commercial |
$197.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.60
|
| Rate for Payer: United Healthcare VA CCN |
$93.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5102851501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.94 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of VT Commercial |
$197.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.40
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.40
|
| Rate for Payer: Multiplan Commercial |
$193.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.80
|
| Rate for Payer: United Healthcare Commercial |
$197.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
5102851501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$268.83 |
| Rate for Payer: Aetna of VT Commercial |
$195.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.80
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$268.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.35
|
| Rate for Payer: Multiplan Commercial |
$193.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare Commercial |
$218.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare VA CCN |
$141.79
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$224.99 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$411.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.86
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.60
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare VA CCN |
$228.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.02 |
| Max. Negotiated Rate |
$477.52 |
| Rate for Payer: Aetna of VT Commercial |
$477.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.47
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$226.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.02
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.02
|
| Rate for Payer: United Healthcare Commercial |
$184.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.02
|
| Rate for Payer: United Healthcare VA CCN |
$120.02
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9822851501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.35 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna of VT Commercial |
$302.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.40
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$254.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.40
|
| Rate for Payer: Multiplan Commercial |
$295.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.30
|
| Rate for Payer: United Healthcare Commercial |
$302.10
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851001
|
|
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 TOE FRACTURE
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
5102851001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.56 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna of VT Commercial |
$209.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.80
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.80
|
| Rate for Payer: Multiplan Commercial |
$205.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.85
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9822851501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna of VT Commercial |
$302.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.81
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$254.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.10
|
| Rate for Payer: Multiplan Commercial |
$295.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.10
|
| Rate for Payer: United Healthcare Commercial |
$302.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.10
|
| Rate for Payer: United Healthcare VA CCN |
$143.10
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9602851501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$389.29 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna of VT Commercial |
$499.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$441.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$420.80
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.80
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.10
|
| Rate for Payer: United Healthcare Commercial |
$499.70
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of VT Commercial |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.96
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare VA CCN |
$129.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9602851501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$232.97 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna of VT Commercial |
$499.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.17
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$236.70
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$236.70
|
| Rate for Payer: United Healthcare Commercial |
$499.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.70
|
| Rate for Payer: United Healthcare VA CCN |
$236.70
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9602851501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$494.44 |
| Rate for Payer: Aetna of VT Commercial |
$494.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.80
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$268.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.35
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare Commercial |
$218.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare VA CCN |
$141.79
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$301.22 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Aetna of VT Commercial |
$386.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.60
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$325.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.60
|
| Rate for Payer: Multiplan Commercial |
$378.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.95
|
| Rate for Payer: United Healthcare Commercial |
$386.65
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.02 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna of VT Commercial |
$270.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.47
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$226.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.02
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.02
|
| Rate for Payer: United Healthcare Commercial |
$184.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.02
|
| Rate for Payer: United Healthcare VA CCN |
$120.02
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$382.58 |
| Rate for Payer: Aetna of VT Commercial |
$382.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.80
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$268.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.35
|
| Rate for Payer: Multiplan Commercial |
$378.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare Commercial |
$218.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare VA CCN |
$141.79
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$375.97 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.40
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9822851501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$298.92 |
| Rate for Payer: Aetna of VT Commercial |
$298.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.80
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$268.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.35
|
| Rate for Payer: Multiplan Commercial |
$295.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare Commercial |
$218.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.79
|
| Rate for Payer: United Healthcare VA CCN |
$141.79
|
|
