|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Aetna of VT Commercial |
$447.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$576.54 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna of VT Commercial |
$740.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$576.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$576.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$654.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$623.20
|
| Rate for Payer: Cash Price |
$389.50
|
| Rate for Payer: Cigna Commercial |
$623.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.20
|
| Rate for Payer: Multiplan Commercial |
$724.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.15
|
| Rate for Payer: United Healthcare Commercial |
$740.05
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9822848501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,068.70 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,212.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,155.20
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$10,651.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$538.93 |
| Max. Negotiated Rate |
$10,011.94 |
| Rate for Payer: Aetna of VT Commercial |
$10,011.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,542.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,542.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$754.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.91
|
| Rate for Payer: Cash Price |
$5,325.50
|
| Rate for Payer: Cash Price |
$5,325.50
|
| Rate for Payer: Cigna Commercial |
$1,026.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$538.93
|
| Rate for Payer: Multiplan Commercial |
$9,905.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare Commercial |
$829.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare VA CCN |
$538.93
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9822847001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Aetna of VT Commercial |
$447.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,068.70 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,212.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,155.20
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna of VT Commercial |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$241.68
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.80
|
| Rate for Payer: United Healthcare Commercial |
$288.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.80
|
| Rate for Payer: United Healthcare VA CCN |
$136.80
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$779.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$732.26 |
| Rate for Payer: Aetna of VT Commercial |
$732.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$697.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$697.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$389.50
|
| Rate for Payer: Cash Price |
$389.50
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$724.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9822847001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.42
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare VA CCN |
$214.20
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.42
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare VA CCN |
$214.20
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9822848501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$538.93 |
| Max. Negotiated Rate |
$1,357.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,357.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$754.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.91
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,026.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$538.93
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare Commercial |
$829.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare VA CCN |
$538.93
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$10,651.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,717.33 |
| Max. Negotiated Rate |
$10,118.45 |
| Rate for Payer: Aetna of VT Commercial |
$10,118.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,542.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,717.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,542.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6,411.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,053.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,627.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,792.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,467.55
|
| Rate for Payer: Cash Price |
$5,325.50
|
| Rate for Payer: Cigna Commercial |
$8,520.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,520.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,520.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,792.95
|
| Rate for Payer: Multiplan Commercial |
$9,905.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,053.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,792.95
|
| Rate for Payer: United Healthcare Commercial |
$10,118.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,792.95
|
| Rate for Payer: United Healthcare VA CCN |
$4,792.95
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$10,651.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7,882.81 |
| Max. Negotiated Rate |
$10,118.45 |
| Rate for Payer: Aetna of VT Commercial |
$10,118.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,882.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,882.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,053.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,946.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,520.80
|
| Rate for Payer: Cash Price |
$5,325.50
|
| Rate for Payer: Cigna Commercial |
$8,520.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,520.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,520.80
|
| Rate for Payer: Multiplan Commercial |
$9,905.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,053.35
|
| Rate for Payer: United Healthcare Commercial |
$10,118.45
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.80
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9602847001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$740.05 |
| Rate for Payer: Aetna of VT Commercial |
$740.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$697.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$697.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$468.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$619.30
|
| Rate for Payer: Cash Price |
$389.50
|
| Rate for Payer: Cigna Commercial |
$623.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$350.55
|
| Rate for Payer: Multiplan Commercial |
$724.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.55
|
| Rate for Payer: United Healthcare Commercial |
$740.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.55
|
| Rate for Payer: United Healthcare VA CCN |
$350.55
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9822848501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$639.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$869.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,169.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$649.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,147.98
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$649.80
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare VA CCN |
$649.80
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9822847001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.80
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.99 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna of VT Commercial |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.20
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.20
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.40
|
| Rate for Payer: United Healthcare Commercial |
$288.80
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$639.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$869.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,169.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$649.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,147.98
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$649.80
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare VA CCN |
$649.80
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
9602848502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$538.93 |
| Max. Negotiated Rate |
$1,357.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,357.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$754.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.91
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,026.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$538.93
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare Commercial |
$829.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare VA CCN |
$538.93
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$9,207.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
5102848501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6,814.10 |
| Max. Negotiated Rate |
$8,746.65 |
| Rate for Payer: Aetna of VT Commercial |
$8,746.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,814.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,814.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,825.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,733.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,365.60
|
| Rate for Payer: Cash Price |
$4,603.50
|
| Rate for Payer: Cigna Commercial |
$7,365.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,365.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,365.60
|
| Rate for Payer: Multiplan Commercial |
$8,562.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,825.95
|
| Rate for Payer: United Healthcare Commercial |
$8,746.65
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$9,207.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
5102848501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$538.93 |
| Max. Negotiated Rate |
$8,654.58 |
| Rate for Payer: Aetna of VT Commercial |
$8,654.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,248.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,248.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$754.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$776.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$619.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.91
|
| Rate for Payer: Cash Price |
$4,603.50
|
| Rate for Payer: Cash Price |
$4,603.50
|
| Rate for Payer: Cigna Commercial |
$1,026.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$538.93
|
| Rate for Payer: Multiplan Commercial |
$8,562.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare Commercial |
$829.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$538.93
|
| Rate for Payer: United Healthcare VA CCN |
$538.93
|
|
|
TREAT METATARSAL FRACTURE
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
5102847001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$383.98 |
| Rate for Payer: Aetna of VT Commercial |
$285.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$9,207.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
5102848501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,077.78 |
| Max. Negotiated Rate |
$8,746.65 |
| Rate for Payer: Aetna of VT Commercial |
$8,746.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,248.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,077.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,248.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,542.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,825.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,457.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,143.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,319.56
|
| Rate for Payer: Cash Price |
$4,603.50
|
| Rate for Payer: Cigna Commercial |
$7,365.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,365.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,365.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,143.15
|
| Rate for Payer: Multiplan Commercial |
$8,562.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,825.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,143.15
|
| Rate for Payer: United Healthcare Commercial |
$8,746.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,143.15
|
| Rate for Payer: United Healthcare VA CCN |
$4,143.15
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9822845001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$357.56 |
| Rate for Payer: Aetna of VT Commercial |
$206.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$348.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.86
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$357.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$208.79
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.88
|
| Rate for Payer: United Healthcare Commercial |
$290.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.88
|
| Rate for Payer: United Healthcare VA CCN |
$188.88
|
|
