|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9822845001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
5102845001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.83 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna of VT Commercial |
$472.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$367.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$367.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$397.60
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$397.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$462.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$422.45
|
| Rate for Payer: United Healthcare Commercial |
$472.15
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$680.20 |
| Rate for Payer: Aetna of VT Commercial |
$680.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$641.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$317.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$641.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$431.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$608.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$579.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$322.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$569.22
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cigna Commercial |
$572.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$572.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$572.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$322.20
|
| Rate for Payer: Multiplan Commercial |
$665.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$608.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$322.20
|
| Rate for Payer: United Healthcare Commercial |
$680.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$322.20
|
| Rate for Payer: United Healthcare VA CCN |
$322.20
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
5102845001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna of VT Commercial |
$472.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$445.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$220.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$445.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$299.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$395.12
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$397.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.65
|
| Rate for Payer: Multiplan Commercial |
$462.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$422.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$223.65
|
| Rate for Payer: United Healthcare Commercial |
$472.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.65
|
| Rate for Payer: United Healthcare VA CCN |
$223.65
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$357.56 |
| 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 |
$194.55
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845002
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$496.32
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
4502845001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.82 |
| Max. Negotiated Rate |
$471.50 |
| Rate for Payer: Aetna of VT Commercial |
$471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$219.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$444.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$298.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$421.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.57
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$397.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.34
|
| Rate for Payer: Multiplan Commercial |
$461.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$223.34
|
| Rate for Payer: United Healthcare Commercial |
$471.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.34
|
| Rate for Payer: United Healthcare VA CCN |
$223.34
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$673.04 |
| Rate for Payer: Aetna of VT Commercial |
$673.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$641.46
|
| 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 |
$641.46
|
| 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 |
$358.00
|
| Rate for Payer: Cash Price |
$358.00
|
| 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 |
$665.88
|
| 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
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9822845001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| 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 |
$97.44
|
| 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 |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$529.91 |
| Max. Negotiated Rate |
$680.20 |
| Rate for Payer: Aetna of VT Commercial |
$680.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$529.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$529.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$608.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$572.80
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cigna Commercial |
$572.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$572.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$572.80
|
| Rate for Payer: Multiplan Commercial |
$665.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$608.60
|
| Rate for Payer: United Healthcare Commercial |
$680.20
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
5102845001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$467.18 |
| Rate for Payer: Aetna of VT Commercial |
$467.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$445.26
|
| 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 |
$445.26
|
| 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 |
$248.50
|
| Rate for Payer: Cash Price |
$248.50
|
| 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 |
$462.21
|
| 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
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| 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 |
$97.44
|
| 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 |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9812845002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$496.32
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
4502845001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.33 |
| Max. Negotiated Rate |
$471.50 |
| Rate for Payer: Aetna of VT Commercial |
$471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$367.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$367.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$421.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$416.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$397.06
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cigna Commercial |
$397.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.06
|
| Rate for Payer: Multiplan Commercial |
$461.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$421.87
|
| Rate for Payer: United Healthcare Commercial |
$471.50
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9602845002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| 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 |
$97.44
|
| 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 |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
5102465001
|
|
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 RADIUS FRACTURE
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
9812465001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$232.93 |
| Max. Negotiated Rate |
$462.88 |
| Rate for Payer: Aetna of VT Commercial |
$244.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$253.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$344.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.65
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$462.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$264.24
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$245.93
|
| Rate for Payer: United Healthcare Commercial |
$378.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.93
|
| Rate for Payer: United Healthcare VA CCN |
$245.93
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
9602465001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$249.35 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna of VT Commercial |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$249.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$338.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$447.58
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.35
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare VA CCN |
$253.35
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
9822466501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$894.66 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,919.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$894.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,216.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,636.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$909.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,605.90
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,616.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,717.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare Commercial |
$1,919.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$909.00
|
| Rate for Payer: United Healthcare VA CCN |
$909.00
|
|
|
TREAT RADIUS FRACTURE
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
9822466501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$628.73 |
| Max. Negotiated Rate |
$1,898.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$647.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$880.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,001.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,001.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$723.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,001.43
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,188.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,044.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,044.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$628.73
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$892.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$628.73
|
| Rate for Payer: United Healthcare Commercial |
$967.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$628.73
|
| Rate for Payer: United Healthcare VA CCN |
$628.73
|
|
|
TREAT RADIUS FRACTURE
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
9812465502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$395.48 |
| Max. Negotiated Rate |
$1,077.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,077.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,026.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,026.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$553.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$758.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$758.28
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$751.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$726.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$726.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.77
|
| Rate for Payer: Multiplan Commercial |
$1,065.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.48
|
| Rate for Payer: United Healthcare Commercial |
$608.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.48
|
| Rate for Payer: United Healthcare VA CCN |
$395.48
|
|
