|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$4,029.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
5102562401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,981.86 |
| Max. Negotiated Rate |
$3,827.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,827.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,981.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,981.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,424.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,384.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,223.20
|
| Rate for Payer: Cash Price |
$2,014.50
|
| Rate for Payer: Cigna Commercial |
$3,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,223.20
|
| Rate for Payer: Multiplan Commercial |
$3,746.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,424.65
|
| Rate for Payer: United Healthcare Commercial |
$3,827.55
|
|
|
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
|
$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
|
$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
|
|
|
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
|
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
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9812562201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$533.17 |
| 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 |
$291.01
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
9812565001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$570.94 |
| 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 |
$311.37
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
$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
|
$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
|
$1.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9812562401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
TREAT WRIST BONE FRACTURE
|
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
|
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
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
9602562402
|
|
Hospital Revenue Code
|
960
|
| 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
|
$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
|
$798.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
9602562202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$758.10 |
| Rate for Payer: Aetna of VT Commercial |
$758.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$480.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$646.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$634.41
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$638.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$638.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.10
|
| Rate for Payer: Multiplan Commercial |
$742.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$678.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$758.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.10
|
| Rate for Payer: United Healthcare VA CCN |
$359.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$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
|
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
|
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
|
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
|
$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 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
|
OP
|
$846.92
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
4502567501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$804.57 |
| Rate for Payer: Aetna of VT Commercial |
$804.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$758.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$375.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$758.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$686.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$381.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$673.30
|
| Rate for Payer: Cash Price |
$423.46
|
| Rate for Payer: Cigna Commercial |
$677.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.11
|
| Rate for Payer: Multiplan Commercial |
$787.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.11
|
| Rate for Payer: United Healthcare Commercial |
$804.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.11
|
| Rate for Payer: United Healthcare VA CCN |
$381.11
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$403.32 |
| Max. Negotiated Rate |
$1,208.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,208.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,152.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$752.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$752.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$463.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$752.93
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$760.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$742.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$742.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$448.93
|
| Rate for Payer: Multiplan Commercial |
$1,195.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$403.32
|
| Rate for Payer: United Healthcare Commercial |
$620.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$403.32
|
| Rate for Payer: United Healthcare VA CCN |
$403.32
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9812569001
|
|
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
|
|
