|
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
|
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
|
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
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9602562401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,346.48 |
| 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 |
$4,746.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,346.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,746.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,189.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,503.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,291.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,211.91
|
| 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: Martins Point Health Care Commercial |
$2,384.10
|
| Rate for Payer: Multiplan Commercial |
$4,927.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,503.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,384.10
|
| Rate for Payer: United Healthcare Commercial |
$5,033.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,384.10
|
| Rate for Payer: United Healthcare VA CCN |
$2,384.10
|
|
|
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
|
OP
|
$906.82
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
4502565001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$401.63 |
| 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 |
$812.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$545.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$408.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.92
|
| 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: Martins Point Health Care Commercial |
$408.07
|
| Rate for Payer: Multiplan Commercial |
$843.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$408.07
|
| Rate for Payer: United Healthcare Commercial |
$861.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.07
|
| Rate for Payer: United Healthcare VA CCN |
$408.07
|
|
|
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
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562402
|
|
Hospital Revenue Code
|
981
|
| 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
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562201
|
|
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
|
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
|
IP
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562202
|
|
Hospital Revenue Code
|
981
|
| 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
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565001
|
|
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
|
$682.44
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
4502562201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.25 |
| 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 |
$611.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$410.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.54
|
| 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: Martins Point Health Care Commercial |
$307.10
|
| Rate for Payer: Multiplan Commercial |
$634.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.10
|
| Rate for Payer: United Healthcare Commercial |
$648.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.10
|
| Rate for Payer: United Healthcare VA CCN |
$307.10
|
|
|
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
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$683.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.49 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Aetna of VT Commercial |
$648.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.40
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.40
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$4,029.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
5102562401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$436.35 |
| Max. Negotiated Rate |
$3,787.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,787.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,609.58
|
| 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 |
$3,609.58
|
| 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 |
$2,014.50
|
| Rate for Payer: Cash Price |
$2,014.50
|
| 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 |
$3,746.97
|
| 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
|
$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
|
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
|
$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
|
OP
|
$2,151.00
|
|
|
Service Code
|
CPT 25628
|
| Hospital Charge Code |
9822562801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$952.68 |
| Max. Negotiated Rate |
$2,043.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,043.45
|
| 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 |
$952.68
|
| 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 |
$1,294.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,828.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,742.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$967.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,710.05
|
| Rate for Payer: Cash Price |
$1,075.50
|
| Rate for Payer: Cigna Commercial |
$1,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,720.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$967.95
|
| Rate for Payer: Multiplan Commercial |
$2,000.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,828.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$967.95
|
| Rate for Payer: United Healthcare Commercial |
$2,043.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$967.95
|
| Rate for Payer: United Healthcare VA CCN |
$967.95
|
|
|
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
|
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
|
$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
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9602565002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
