|
TREAT THUMB DISLOCATION
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
9812664102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$375.08 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna of VT Commercial |
$828.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$386.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$525.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$618.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$618.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$431.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$618.02
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cigna Commercial |
$708.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$679.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$679.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$412.66
|
| Rate for Payer: Multiplan Commercial |
$819.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$375.08
|
| Rate for Payer: United Healthcare Commercial |
$576.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.08
|
| Rate for Payer: United Healthcare VA CCN |
$375.08
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664501
|
|
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 THUMB FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664501
|
|
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 THUMB FRACTURE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$385.51 |
| Max. Negotiated Rate |
$1,006.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,006.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$397.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$539.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$443.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.72
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$728.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$700.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$700.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.38
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$547.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare Commercial |
$593.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare VA CCN |
$385.51
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$474.35 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$474.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$644.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$867.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$851.45
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$481.95
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare VA CCN |
$481.95
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$953.06
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
4502664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$422.11 |
| Max. Negotiated Rate |
$905.41 |
| Rate for Payer: Aetna of VT Commercial |
$905.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$422.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.68
|
| Rate for Payer: Cash Price |
$476.53
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.88
|
| Rate for Payer: Multiplan Commercial |
$886.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.88
|
| Rate for Payer: United Healthcare Commercial |
$905.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.88
|
| Rate for Payer: United Healthcare VA CCN |
$428.88
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9822664501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$792.65 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$899.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$856.80
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
|
|
TREAT THUMB FRACTURE
|
Professional
|
Both
|
$1,598.00
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
9822665001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$467.66 |
| Max. Negotiated Rate |
$1,502.12 |
| Rate for Payer: Aetna of VT Commercial |
$1,502.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,431.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$481.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,431.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$654.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$914.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$914.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$537.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$914.33
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cigna Commercial |
$882.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$771.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$771.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.66
|
| Rate for Payer: Multiplan Commercial |
$1,486.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$664.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.66
|
| Rate for Payer: United Healthcare Commercial |
$719.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.66
|
| Rate for Payer: United Healthcare VA CCN |
$467.66
|
|
|
TREAT THUMB FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$728.47 |
| 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 |
$397.08
|
| 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 |
$539.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$443.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$728.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$700.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$700.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.38
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$547.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare Commercial |
$593.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare VA CCN |
$385.51
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9822664501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$474.35 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$474.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$644.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$867.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$851.45
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$481.95
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.95
|
| Rate for Payer: United Healthcare VA CCN |
$481.95
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9812664502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$792.65 |
| Max. Negotiated Rate |
$1,017.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,017.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$792.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$910.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$899.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$856.80
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$856.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$856.80
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$910.35
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
|
|
TREAT THUMB FRACTURE
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
9822664501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$385.51 |
| Max. Negotiated Rate |
$1,006.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,006.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$397.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$959.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$539.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$662.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$443.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.72
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$728.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$700.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$700.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.38
|
| Rate for Payer: Multiplan Commercial |
$996.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$547.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare Commercial |
$593.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$385.51
|
| Rate for Payer: United Healthcare VA CCN |
$385.51
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,598.00
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
9822665001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,182.68 |
| Max. Negotiated Rate |
$1,518.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,518.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,182.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,182.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,358.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,342.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,278.40
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,278.40
|
| Rate for Payer: Multiplan Commercial |
$1,486.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,358.30
|
| Rate for Payer: United Healthcare Commercial |
$1,518.10
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$953.06
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
4502664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.36 |
| Max. Negotiated Rate |
$905.41 |
| Rate for Payer: Aetna of VT Commercial |
$905.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$762.45
|
| Rate for Payer: Cash Price |
$476.53
|
| Rate for Payer: Cigna Commercial |
$762.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.45
|
| Rate for Payer: Multiplan Commercial |
$886.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.10
|
| Rate for Payer: United Healthcare Commercial |
$905.41
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,598.00
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
9822665001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$707.75 |
| Max. Negotiated Rate |
$1,518.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,518.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,431.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$707.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,431.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$962.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,358.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,294.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,270.41
|
| Rate for Payer: Cash Price |
$799.00
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$719.10
|
| Rate for Payer: Multiplan Commercial |
$1,486.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,358.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$719.10
|
| Rate for Payer: United Healthcare Commercial |
$1,518.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$719.10
|
| Rate for Payer: United Healthcare VA CCN |
$719.10
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
4502863001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$132.61 |
| Rate for Payer: Aetna of VT Commercial |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.67
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9812863001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$243.78 |
| 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 |
$108.62
|
| 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 |
$147.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.39
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.49
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.46
|
| Rate for Payer: United Healthcare Commercial |
$162.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.46
|
| Rate for Payer: United Healthcare VA CCN |
$105.46
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9812863002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$169.19 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Aetna of VT Commercial |
$362.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$342.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$342.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$303.69
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$305.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.90
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$324.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.90
|
| Rate for Payer: United Healthcare Commercial |
$362.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.90
|
| Rate for Payer: United Healthcare VA CCN |
$171.90
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9822866501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$162.99 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.56
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare VA CCN |
$165.60
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9822866501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna of VT Commercial |
$345.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.80
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$230.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.91
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$186.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare VA CCN |
$121.18
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9812863002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$359.08 |
| Rate for Payer: Aetna of VT Commercial |
$359.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$342.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$342.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.39
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.49
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.46
|
| Rate for Payer: United Healthcare Commercial |
$162.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.46
|
| Rate for Payer: United Healthcare VA CCN |
$105.46
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9822866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$236.83 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of VT Commercial |
$304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.00
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.00
|
| Rate for Payer: United Healthcare Commercial |
$304.00
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9822866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.73 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of VT Commercial |
$304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.40
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.00
|
| Rate for Payer: United Healthcare Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.00
|
| Rate for Payer: United Healthcare VA CCN |
$144.00
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9822866501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$294.40
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9822866001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: Aetna of VT Commercial |
$300.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.33
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$170.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.71
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare Commercial |
$137.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare VA CCN |
$89.58
|
|
