|
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
|
$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
|
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
|
|
|
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
|
$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
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851502
|
|
Hospital Revenue Code
|
981
|
| 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
|
$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 |
9602851502
|
|
Hospital Revenue Code
|
960
|
| 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
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9602851502
|
|
Hospital Revenue Code
|
960
|
| 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
|
$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
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9812851002
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
$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
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
5102851001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.02 |
| Max. Negotiated Rate |
$226.58 |
| Rate for Payer: Aetna of VT Commercial |
$207.74
|
| 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 |
$123.62
|
| 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 |
$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 |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| 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 |
$205.53
|
| 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
|
$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 |
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
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9812851502
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
9602660001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$612.06 |
| Max. Negotiated Rate |
$785.65 |
| Rate for Payer: Aetna of VT Commercial |
$785.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$612.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$612.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$702.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$694.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$661.60
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$661.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$661.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$661.60
|
| Rate for Payer: Multiplan Commercial |
$769.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$702.95
|
| Rate for Payer: United Healthcare Commercial |
$785.65
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
9602660001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$286.81 |
| Max. Negotiated Rate |
$777.38 |
| Rate for Payer: Aetna of VT Commercial |
$777.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$740.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$295.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$740.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$401.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$329.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$368.04
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$540.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.94
|
| Rate for Payer: Multiplan Commercial |
$769.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$407.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$286.81
|
| Rate for Payer: United Healthcare Commercial |
$441.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.81
|
| Rate for Payer: United Healthcare VA CCN |
$286.81
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
9812660502
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
|
|
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
|
Facility
|
OP
|
$2,720.00
|
|
|
Service Code
|
CPT 26608
|
| Hospital Charge Code |
9602660801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,204.69 |
| 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 |
$2,436.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,204.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,436.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,312.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,203.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,224.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,162.40
|
| 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: Martins Point Health Care Commercial |
$1,224.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,312.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,224.00
|
| Rate for Payer: United Healthcare Commercial |
$2,584.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,224.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,224.00
|
|
|
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
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
9812660002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Aetna of VT Commercial |
$614.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$286.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$389.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.37
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.15
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.15
|
| Rate for Payer: United Healthcare Commercial |
$614.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.15
|
| Rate for Payer: United Healthcare VA CCN |
$291.15
|
|
