|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$207.83
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
4502851501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.26
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851002
|
|
Hospital Revenue Code
|
981
|
| 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
|
$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
|
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
|
$220.80
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
4502851001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.41 |
| 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 |
$163.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.64
|
| 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: Multiplan Commercial |
$205.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.68
|
| Rate for Payer: United Healthcare Commercial |
$209.76
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$207.83
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
4502851501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.22
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.52
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.52
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.52
|
| Rate for Payer: United Healthcare VA CCN |
$93.52
|
|
|
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
|
|
|
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
|
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
|
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
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$226.58 |
| 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 |
$123.62
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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 |
9602851502
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
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
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$213.15 |
| 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 |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.40
|
| 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: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9602851002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.15 |
| 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 |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.40
|
| 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: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
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
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
9602661502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,060.56 |
| Max. Negotiated Rate |
$1,361.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,361.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,060.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,203.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,146.40
|
| Rate for Payer: Cash Price |
$716.50
|
| Rate for Payer: Cigna Commercial |
$1,146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,146.40
|
| Rate for Payer: Multiplan Commercial |
$1,332.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,218.05
|
| Rate for Payer: United Healthcare Commercial |
$1,361.35
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$2,720.00
|
|
|
Service Code
|
CPT 26608
|
| Hospital Charge Code |
9602660801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,013.07 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,584.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,013.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,013.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,312.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,284.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,176.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cigna Commercial |
$2,176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,176.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,312.00
|
| Rate for Payer: United Healthcare Commercial |
$2,584.00
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9812660502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$378.68 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna of VT Commercial |
$812.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$378.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$514.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.73
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$684.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$726.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$812.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.75
|
| Rate for Payer: United Healthcare VA CCN |
$384.75
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9812660501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$706.80 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Aetna of VT Commercial |
$907.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$706.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$706.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$811.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$802.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$764.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$764.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$764.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$764.00
|
| Rate for Payer: Multiplan Commercial |
$888.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$811.75
|
| Rate for Payer: United Healthcare Commercial |
$907.25
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$2,761.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
9602661501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$553.56 |
| Max. Negotiated Rate |
$2,595.34 |
| Rate for Payer: Aetna of VT Commercial |
$2,595.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,473.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$570.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,473.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$774.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$770.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$636.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$770.39
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna Commercial |
$1,045.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$917.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$917.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$553.56
|
| Rate for Payer: Multiplan Commercial |
$2,567.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$786.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$553.56
|
| Rate for Payer: United Healthcare Commercial |
$851.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$553.56
|
| Rate for Payer: United Healthcare VA CCN |
$553.56
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9602660502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$632.79 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna of VT Commercial |
$812.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.00
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$726.75
|
| Rate for Payer: United Healthcare Commercial |
$812.25
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9602660502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$293.72 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna of VT Commercial |
$803.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$509.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$509.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$509.72
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$555.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.48
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.72
|
| Rate for Payer: United Healthcare Commercial |
$451.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.72
|
| Rate for Payer: United Healthcare VA CCN |
$293.72
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
5102660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$466.26 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna of VT Commercial |
$598.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$535.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$504.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$504.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$585.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$598.50
|
|
