|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
5102467001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.39 |
| 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 |
$195.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$211.20
|
| 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: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
|
|
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
|
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
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9602467002
|
|
Hospital Revenue Code
|
960
|
| 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
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9602467002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
$292.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
9812467001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$216.11 |
| 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 |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.60
|
| 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: Multiplan Commercial |
$271.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.20
|
| Rate for Payer: United Healthcare Commercial |
$277.40
|
|
|
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 WRIST BONE FRACTURE
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9822565001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$302.30 |
| Max. Negotiated Rate |
$809.34 |
| Rate for Payer: Aetna of VT Commercial |
$809.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$311.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$423.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$537.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$347.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$537.61
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$570.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.06
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$302.30
|
| Rate for Payer: United Healthcare Commercial |
$465.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.30
|
| Rate for Payer: United Healthcare VA CCN |
$302.30
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$282.53 |
| Max. Negotiated Rate |
$750.12 |
| Rate for Payer: Aetna of VT Commercial |
$750.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$291.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$395.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$418.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$324.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.63
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$533.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$503.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$503.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.94
|
| Rate for Payer: Multiplan Commercial |
$742.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$401.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.53
|
| Rate for Payer: United Healthcare Commercial |
$434.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.53
|
| Rate for Payer: United Healthcare VA CCN |
$282.53
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$758.10 |
| Rate for Payer: Aetna of VT Commercial |
$758.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$480.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$646.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$634.41
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$638.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.10
|
| Rate for Payer: Multiplan Commercial |
$742.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$678.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$758.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare VA CCN |
$359.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9822565001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$637.23 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.80
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9822565001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$381.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$518.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$697.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.45
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare VA CCN |
$387.45
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$4,028.02
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
4502562401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,981.14 |
| Max. Negotiated Rate |
$3,826.62 |
| Rate for Payer: Aetna of VT Commercial |
$3,826.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,981.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,981.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,423.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,383.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,222.42
|
| Rate for Payer: Cash Price |
$2,014.01
|
| Rate for Payer: Cigna Commercial |
$3,222.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,222.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,222.42
|
| Rate for Payer: Multiplan Commercial |
$3,746.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,423.82
|
| Rate for Payer: United Healthcare Commercial |
$3,826.62
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$436.35 |
| Max. Negotiated Rate |
$1,193.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,137.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,137.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$610.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$794.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$794.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$501.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$794.06
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$823.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$796.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$796.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$483.24
|
| Rate for Payer: Multiplan Commercial |
$1,181.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$436.35
|
| Rate for Payer: United Healthcare Commercial |
$671.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$436.35
|
| Rate for Payer: United Healthcare VA CCN |
$436.35
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
5102565001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$671.27 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.60
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562201
|
|
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 WRIST BONE FRACTURE
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,308.50 |
| Max. Negotiated Rate |
$1,679.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,679.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,308.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,308.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,502.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,485.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,414.40
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,414.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,414.40
|
| Rate for Payer: Multiplan Commercial |
$1,644.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,502.80
|
| Rate for Payer: United Healthcare Commercial |
$1,679.60
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$2,151.00
|
|
|
Service Code
|
CPT 25628
|
| Hospital Charge Code |
9822562801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$685.99 |
| Max. Negotiated Rate |
$2,021.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,021.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,927.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$706.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,927.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$960.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,204.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,204.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$788.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,204.27
|
| Rate for Payer: Cash Price |
$1,075.50
|
| Rate for Payer: Cash Price |
$1,075.50
|
| Rate for Payer: Cigna Commercial |
$1,295.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,139.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,139.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$685.99
|
| Rate for Payer: Multiplan Commercial |
$2,000.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$974.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$685.99
|
| Rate for Payer: United Healthcare Commercial |
$1,055.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$685.99
|
| Rate for Payer: United Healthcare VA CCN |
$685.99
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$302.30 |
| Max. Negotiated Rate |
$809.34 |
| Rate for Payer: Aetna of VT Commercial |
$809.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$311.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$423.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$537.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$347.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$537.61
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$570.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.06
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$302.30
|
| Rate for Payer: United Healthcare Commercial |
$465.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.30
|
| Rate for Payer: United Healthcare VA CCN |
$302.30
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9822562401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$939.93 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,206.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$939.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$939.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,079.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,066.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,016.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,016.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,016.00
|
| Rate for Payer: Multiplan Commercial |
$1,181.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,079.50
|
| Rate for Payer: United Healthcare Commercial |
$1,206.50
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$682.44
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
4502562201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.07 |
| Max. Negotiated Rate |
$648.32 |
| Rate for Payer: Aetna of VT Commercial |
$648.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.95
|
| Rate for Payer: Cash Price |
$341.22
|
| Rate for Payer: Cigna Commercial |
$545.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.95
|
| Rate for Payer: Multiplan Commercial |
$634.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.07
|
| Rate for Payer: United Healthcare Commercial |
$648.32
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562401
|
|
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 WRIST BONE FRACTURE
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$758.10 |
| Rate for Payer: Aetna of VT Commercial |
$758.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$480.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$646.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$634.41
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$638.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.10
|
| Rate for Payer: Multiplan Commercial |
$742.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$678.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$758.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare VA CCN |
$359.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$381.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$518.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$697.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.45
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare VA CCN |
$387.45
|
|
