|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562202
|
|
Hospital Revenue Code
|
960
|
| 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 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
|
$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
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9822562401
|
|
Hospital Revenue Code
|
982
|
| 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
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562402
|
|
Hospital Revenue Code
|
981
|
| 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
|
$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
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565001
|
|
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
|
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
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.53 |
| Max. Negotiated Rate |
$642.02 |
| Rate for Payer: Aetna of VT Commercial |
$642.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.90
|
| 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 |
$611.90
|
| 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 |
$341.50
|
| Rate for Payer: Cash Price |
$341.50
|
| 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 |
$635.19
|
| 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 |
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
|
$1,480.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$655.49 |
| 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 |
$1,325.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$655.49
|
| 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 |
$890.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,258.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,198.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$666.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,176.60
|
| 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: Martins Point Health Care Commercial |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,258.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$666.00
|
| Rate for Payer: United Healthcare Commercial |
$1,406.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$666.00
|
| Rate for Payer: United Healthcare VA CCN |
$666.00
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$2,151.00
|
|
|
Service Code
|
CPT 25628
|
| Hospital Charge Code |
9822562801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,591.96 |
| 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 |
$1,591.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,591.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,828.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,806.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,720.80
|
| 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: Multiplan Commercial |
$2,000.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,828.35
|
| Rate for Payer: United Healthcare Commercial |
$2,043.45
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$823.75 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.44
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
$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
|
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
|
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
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
5102562201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$302.50 |
| 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 |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$553.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.99
|
| 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: Martins Point Health Care Commercial |
$307.35
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare VA CCN |
$307.35
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9822562201
|
|
Hospital Revenue Code
|
982
|
| 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
|
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
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565002
|
|
Hospital Revenue Code
|
981
|
| 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
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9602562402
|
|
Hospital Revenue Code
|
960
|
| 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 DISLOCATION
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$324.90 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna of VT Commercial |
$417.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.20
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$351.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$408.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.15
|
| Rate for Payer: United Healthcare Commercial |
$417.05
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9812567502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$324.90 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna of VT Commercial |
$417.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.20
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$351.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$408.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.15
|
| Rate for Payer: United Healthcare Commercial |
$417.05
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9602566001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$437.55 |
| Max. Negotiated Rate |
$962.56 |
| Rate for Payer: Aetna of VT Commercial |
$962.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$450.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$612.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$693.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$693.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$503.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$693.05
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$826.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$724.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$724.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.55
|
| Rate for Payer: Multiplan Commercial |
$952.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$621.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.55
|
| Rate for Payer: United Healthcare Commercial |
$673.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.55
|
| Rate for Payer: United Healthcare VA CCN |
$437.55
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9602566002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.92 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna of VT Commercial |
$392.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$334.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.33
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$330.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$330.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$330.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.85
|
| Rate for Payer: Multiplan Commercial |
$384.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.85
|
| Rate for Payer: United Healthcare Commercial |
$392.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.85
|
| Rate for Payer: United Healthcare VA CCN |
$185.85
|
|
