|
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
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9812863001
|
|
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 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
|
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
|
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
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9602863001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.80
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
4502863001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.82 |
| 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 |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.97
|
| 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: Martins Point Health Care Commercial |
$62.82
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare VA CCN |
$62.82
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9602863002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
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
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9602863001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.19
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.45
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare VA CCN |
$234.45
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9602863002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$282.72 |
| 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 |
$282.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$282.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.60
|
| 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: Multiplan Commercial |
$355.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$324.70
|
| Rate for Payer: United Healthcare Commercial |
$362.90
|
|
|
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 ULNAR FRACTURE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9812467001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna of VT Commercial |
$277.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.14
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$271.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.40
|
| Rate for Payer: United Healthcare Commercial |
$277.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.40
|
| Rate for Payer: United Healthcare VA CCN |
$131.40
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
9822468501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$957.55 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,053.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,936.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$957.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,936.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,301.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,837.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,751.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$972.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,718.79
|
| Rate for Payer: Cash Price |
$1,081.00
|
| Rate for Payer: Cigna Commercial |
$1,729.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,729.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,729.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$972.90
|
| Rate for Payer: Multiplan Commercial |
$2,010.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,837.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$972.90
|
| Rate for Payer: United Healthcare Commercial |
$2,053.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$972.90
|
| Rate for Payer: United Healthcare VA CCN |
$972.90
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
9822468501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,600.10 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,053.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,600.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,837.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,816.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,729.60
|
| Rate for Payer: Cash Price |
$1,081.00
|
| Rate for Payer: Cigna Commercial |
$1,729.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,729.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,729.60
|
| Rate for Payer: Multiplan Commercial |
$2,010.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare Commercial |
$2,053.90
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9812467002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$322.43 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Aetna of VT Commercial |
$691.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$652.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$652.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$618.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$589.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$578.76
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$582.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$582.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$582.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.60
|
| Rate for Payer: Multiplan Commercial |
$677.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$618.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$327.60
|
| Rate for Payer: United Healthcare Commercial |
$691.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.60
|
| Rate for Payer: United Healthcare VA CCN |
$327.60
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$263.45
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
4502467001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.68 |
| Max. Negotiated Rate |
$250.28 |
| Rate for Payer: Aetna of VT Commercial |
$250.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.44
|
| Rate for Payer: Cash Price |
$131.72
|
| Rate for Payer: Cigna Commercial |
$210.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.55
|
| Rate for Payer: Multiplan Commercial |
$245.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.55
|
| Rate for Payer: United Healthcare Commercial |
$250.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.55
|
| Rate for Payer: United Healthcare VA CCN |
$118.55
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$263.45
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
4502467001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.98 |
| Max. Negotiated Rate |
$250.28 |
| Rate for Payer: Aetna of VT Commercial |
$250.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.76
|
| Rate for Payer: Cash Price |
$131.72
|
| Rate for Payer: Cigna Commercial |
$210.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.76
|
| Rate for Payer: Multiplan Commercial |
$245.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.93
|
| Rate for Payer: United Healthcare Commercial |
$250.28
|
|
|
TREAT ULNAR FRACTURE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
5102467001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.52 |
| Max. Negotiated Rate |
$501.21 |
| Rate for Payer: Aetna of VT Commercial |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$371.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$409.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$409.61
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$501.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.18
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.49
|
| Rate for Payer: United Healthcare Commercial |
$408.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.49
|
| Rate for Payer: United Healthcare VA CCN |
$265.49
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9602467001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$438.91 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Aetna of VT Commercial |
$941.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$887.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$438.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$887.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$596.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$842.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$802.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$787.85
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$792.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$445.95
|
| Rate for Payer: Multiplan Commercial |
$921.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$842.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$445.95
|
| Rate for Payer: United Healthcare Commercial |
$941.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$445.95
|
| Rate for Payer: United Healthcare VA CCN |
$445.95
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9812467002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$538.79 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Aetna of VT Commercial |
$691.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$618.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.40
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$582.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$582.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$582.40
|
| Rate for Payer: Multiplan Commercial |
$677.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$618.80
|
| Rate for Payer: United Healthcare Commercial |
$691.60
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9602467001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.44 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Aetna of VT Commercial |
$941.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$733.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$733.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$842.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$832.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$792.80
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$792.80
|
| Rate for Payer: Multiplan Commercial |
$921.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$842.35
|
| Rate for Payer: United Healthcare Commercial |
$941.45
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
5102467001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna of VT Commercial |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.88
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare VA CCN |
$118.80
|
|
|
TREAT ULNAR FRACTURE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
9822468501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$623.44 |
| Max. Negotiated Rate |
$2,032.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,032.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,936.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$642.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,936.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$872.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,059.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,059.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$716.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,059.52
|
| Rate for Payer: Cash Price |
$1,081.00
|
| Rate for Payer: Cash Price |
$1,081.00
|
| Rate for Payer: Cigna Commercial |
$1,180.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,035.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,035.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$623.44
|
| Rate for Payer: Multiplan Commercial |
$2,010.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$623.44
|
| Rate for Payer: United Healthcare Commercial |
$959.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$623.44
|
| Rate for Payer: United Healthcare VA CCN |
$623.44
|
|
