|
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
|
|
|
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
|
$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
|
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
|
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
|
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 |
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
|
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 WRIST BONE FRACTURE
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9602562401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,921.05 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Aetna of VT Commercial |
$5,033.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,921.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,921.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,503.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,450.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,238.40
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$4,238.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,238.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,238.40
|
| Rate for Payer: Multiplan Commercial |
$4,927.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,503.30
|
| Rate for Payer: United Healthcare Commercial |
$5,033.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,095.35 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,406.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,095.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,095.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,258.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,243.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,184.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cigna Commercial |
$1,184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,184.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare Commercial |
$1,406.00
|
|
|
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
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9822562401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$562.48 |
| 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 |
$1,137.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$562.48
|
| 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 |
$764.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,079.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,028.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$571.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,009.65
|
| 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: Martins Point Health Care Commercial |
$571.50
|
| Rate for Payer: Multiplan Commercial |
$1,181.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,079.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$571.50
|
| Rate for Payer: United Healthcare Commercial |
$1,206.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.50
|
| Rate for Payer: United Healthcare VA CCN |
$571.50
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$1,768.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$302.30 |
| Max. Negotiated Rate |
$1,661.92 |
| Rate for Payer: Aetna of VT Commercial |
$1,661.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,583.95
|
| 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 |
$1,583.95
|
| 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 |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| 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 |
$1,644.24
|
| 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
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9602562402
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$282.53 |
| Max. Negotiated Rate |
$1,391.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,391.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,325.93
|
| 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 |
$1,325.93
|
| 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 |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| 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 |
$1,376.40
|
| 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
|
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
|
IP
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9822562201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$590.60 |
| 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 |
$590.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$590.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$670.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$638.40
|
| 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: Multiplan Commercial |
$742.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$678.30
|
| Rate for Payer: United Healthcare Commercial |
$758.10
|
|
|
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
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562401
|
|
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
|
$906.82
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
4502565001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$671.14 |
| Max. Negotiated Rate |
$861.48 |
| Rate for Payer: Aetna of VT Commercial |
$861.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$671.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$671.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.46
|
| Rate for Payer: Cash Price |
$453.41
|
| Rate for Payer: Cigna Commercial |
$725.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.46
|
| Rate for Payer: Multiplan Commercial |
$843.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.80
|
| Rate for Payer: United Healthcare Commercial |
$861.48
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$783.05 |
| 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 |
$1,583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$783.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,583.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,502.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,432.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,405.56
|
| 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: Martins Point Health Care Commercial |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$1,644.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,502.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$795.60
|
| Rate for Payer: United Healthcare Commercial |
$1,679.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$795.60
|
| Rate for Payer: United Healthcare VA CCN |
$795.60
|
|
|
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
|
Facility
|
OP
|
$4,028.02
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
4502562401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,784.01 |
| 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 |
$3,608.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,784.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,608.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,424.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,423.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,262.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,812.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,202.28
|
| 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: Martins Point Health Care Commercial |
$1,812.61
|
| Rate for Payer: Multiplan Commercial |
$3,746.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,423.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,812.61
|
| Rate for Payer: United Healthcare Commercial |
$3,826.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,812.61
|
| Rate for Payer: United Healthcare VA CCN |
$1,812.61
|
|
