|
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
|
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
|
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
|
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
|
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
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$180.26 |
| 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 |
$364.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.26
|
| 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 |
$245.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$329.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.56
|
| 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: Martins Point Health Care Commercial |
$183.15
|
| Rate for Payer: Multiplan Commercial |
$378.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$183.15
|
| Rate for Payer: United Healthcare Commercial |
$386.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.15
|
| Rate for Payer: United Healthcare VA CCN |
$183.15
|
|
|
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
|
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
|
$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
|
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
|
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
|
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
|
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
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851502
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
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
|
$221.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
5102851001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.88 |
| 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 |
$197.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.69
|
| 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: Martins Point Health Care Commercial |
$99.45
|
| Rate for Payer: Multiplan Commercial |
$205.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.45
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.45
|
| Rate for Payer: United Healthcare VA CCN |
$99.45
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$180.69
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
4502660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.73 |
| Max. Negotiated Rate |
$171.66 |
| Rate for Payer: Aetna of VT Commercial |
$171.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.55
|
| Rate for Payer: Cash Price |
$90.34
|
| Rate for Payer: Cigna Commercial |
$144.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.55
|
| Rate for Payer: Multiplan Commercial |
$168.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.59
|
| Rate for Payer: United Healthcare Commercial |
$171.66
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9812660501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$293.72 |
| Max. Negotiated Rate |
$897.70 |
| Rate for Payer: Aetna of VT Commercial |
$897.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$855.58
|
| 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 |
$855.58
|
| 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 |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| 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 |
$888.15
|
| 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
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
9602661502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$634.68 |
| 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 |
$1,283.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$634.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,283.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$862.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,160.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$644.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,139.23
|
| 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: Martins Point Health Care Commercial |
$644.85
|
| Rate for Payer: Multiplan Commercial |
$1,332.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,218.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$644.85
|
| Rate for Payer: United Healthcare Commercial |
$1,361.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$644.85
|
| Rate for Payer: United Healthcare VA CCN |
$644.85
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9602660501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,099.05 |
| Max. Negotiated Rate |
$1,410.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,410.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,099.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,099.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,262.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,247.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.00
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,188.00
|
| Rate for Payer: Multiplan Commercial |
$1,381.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,262.25
|
| Rate for Payer: United Healthcare Commercial |
$1,410.75
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9602660501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$293.72 |
| Max. Negotiated Rate |
$1,395.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,395.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,330.41
|
| 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 |
$1,330.41
|
| 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 |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| 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 |
$1,381.05
|
| 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
|
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
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
9602661501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,222.85 |
| Max. Negotiated Rate |
$2,622.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,622.95
|
| 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 |
$1,222.85
|
| 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 |
$1,662.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,346.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,236.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,242.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,194.99
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna Commercial |
$2,208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,242.45
|
| Rate for Payer: Multiplan Commercial |
$2,567.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,346.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,242.45
|
| Rate for Payer: United Healthcare Commercial |
$2,622.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,242.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,242.45
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
5102661501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$983.59 |
| Max. Negotiated Rate |
$1,262.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,262.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$983.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$983.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,129.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,116.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,063.20
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$1,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,063.20
|
| Rate for Payer: Multiplan Commercial |
$1,235.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,129.65
|
| Rate for Payer: United Healthcare Commercial |
$1,262.55
|
|
