|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9602566002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$370.01 |
| Max. Negotiated Rate |
$826.67 |
| Rate for Payer: Aetna of VT Commercial |
$388.22
|
| 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 |
$450.68
|
| 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 |
$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 |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| 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 |
$384.09
|
| 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
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$951.77 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,221.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$951.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$951.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,093.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,080.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,028.80
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,028.80
|
| Rate for Payer: Multiplan Commercial |
$1,195.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,093.10
|
| Rate for Payer: United Healthcare Commercial |
$1,221.70
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
5102566001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$437.55 |
| Max. Negotiated Rate |
$826.67 |
| Rate for Payer: Aetna of VT Commercial |
$575.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$548.29
|
| 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 |
$548.29
|
| 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 |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| 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 |
$569.16
|
| 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
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
5102566001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.94 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna of VT Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$489.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$489.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$489.60
|
| Rate for Payer: Multiplan Commercial |
$569.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$520.20
|
| Rate for Payer: United Healthcare Commercial |
$581.40
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9812569001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$901.48 |
| 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 |
$490.48
|
| 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 |
$666.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.39
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$901.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$788.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$788.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$476.20
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare Commercial |
$732.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare VA CCN |
$476.19
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$393.30 |
| Max. Negotiated Rate |
$760.63 |
| Rate for Payer: Aetna of VT Commercial |
$412.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$393.30
|
| 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 |
$393.30
|
| 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 |
$219.50
|
| Rate for Payer: Cash Price |
$219.50
|
| 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 |
$408.27
|
| 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
|
$2,443.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
5102569001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,808.06 |
| Max. Negotiated Rate |
$2,320.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,320.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,808.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,808.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,076.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,052.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,954.40
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$1,954.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,954.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,954.40
|
| Rate for Payer: Multiplan Commercial |
$2,271.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,076.55
|
| Rate for Payer: United Healthcare Commercial |
$2,320.85
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9812566002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$370.01 |
| Max. Negotiated Rate |
$826.67 |
| Rate for Payer: Aetna of VT Commercial |
$388.22
|
| 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 |
$450.68
|
| 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 |
$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 |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| 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 |
$384.09
|
| 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
|
$1.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9812569001
|
|
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 DISLOCATION
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9822569001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$433.62 |
| Max. Negotiated Rate |
$901.48 |
| Rate for Payer: Aetna of VT Commercial |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$490.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$666.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.39
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$901.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$788.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$788.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$476.20
|
| Rate for Payer: Multiplan Commercial |
$450.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare Commercial |
$732.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare VA CCN |
$476.19
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9602569002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$433.62 |
| Max. Negotiated Rate |
$901.48 |
| Rate for Payer: Aetna of VT Commercial |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$490.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$666.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.39
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$901.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$788.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$788.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$476.20
|
| Rate for Payer: Multiplan Commercial |
$450.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare Commercial |
$732.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare VA CCN |
$476.19
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9822569001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$214.36 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna of VT Commercial |
$459.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$214.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$291.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$411.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.78
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$387.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$387.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$387.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.80
|
| Rate for Payer: Multiplan Commercial |
$450.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$411.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.80
|
| Rate for Payer: United Healthcare Commercial |
$459.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.80
|
| Rate for Payer: United Healthcare VA CCN |
$217.80
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
5102567501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$626.86 |
| Max. Negotiated Rate |
$804.65 |
| Rate for Payer: Aetna of VT Commercial |
$804.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.60
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$677.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.60
|
| Rate for Payer: Multiplan Commercial |
$787.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.95
|
| Rate for Payer: United Healthcare Commercial |
$804.65
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
5102566001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna of VT Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$548.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$271.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$548.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$368.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$495.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$486.54
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$489.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$489.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$489.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$275.40
|
| Rate for Payer: Multiplan Commercial |
$569.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$520.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$275.40
|
| Rate for Payer: United Healthcare Commercial |
$581.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.40
|
| Rate for Payer: United Healthcare VA CCN |
$275.40
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9602566001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$453.53 |
| Max. Negotiated Rate |
$972.80 |
| Rate for Payer: Aetna of VT Commercial |
$972.80
|
| 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 |
$453.53
|
| 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 |
$616.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$870.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$829.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$460.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$814.08
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$460.80
|
| Rate for Payer: Multiplan Commercial |
$952.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$460.80
|
| Rate for Payer: United Healthcare Commercial |
$972.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.80
|
| Rate for Payer: United Healthcare VA CCN |
$460.80
|
|
|
TREAT WRIST DISLOCATION
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
9602569001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$476.19 |
| Max. Negotiated Rate |
$2,751.38 |
| Rate for Payer: Aetna of VT Commercial |
$2,751.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,622.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$490.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,622.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$666.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.39
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cigna Commercial |
$901.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$788.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$788.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$476.20
|
| Rate for Payer: Multiplan Commercial |
$2,722.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$676.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare Commercial |
$732.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.19
|
| Rate for Payer: United Healthcare VA CCN |
$476.19
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$611.35
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
4502566001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.46 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: Aetna of VT Commercial |
$580.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$489.08
|
| Rate for Payer: Cash Price |
$305.68
|
| Rate for Payer: Cigna Commercial |
$489.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$489.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$489.08
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.65
|
| Rate for Payer: United Healthcare Commercial |
$580.78
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$569.57 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,221.70
|
| 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 |
$569.57
|
| 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 |
$774.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,093.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,041.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$578.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,022.37
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,028.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,028.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$578.70
|
| Rate for Payer: Multiplan Commercial |
$1,195.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,093.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$578.70
|
| Rate for Payer: United Healthcare Commercial |
$1,221.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.70
|
| Rate for Payer: United Healthcare VA CCN |
$578.70
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9812566001
|
|
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 DISLOCATION
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
9812566002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$305.66 |
| 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 |
$305.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$305.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$346.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$330.40
|
| 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: Multiplan Commercial |
$384.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.05
|
| Rate for Payer: United Healthcare Commercial |
$392.35
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9812567501
|
|
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 DISLOCATION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9812567501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$760.63 |
| 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 |
$415.42
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
$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
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
9602567502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$194.43 |
| 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 |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.00
|
| 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: Martins Point Health Care Commercial |
$197.55
|
| Rate for Payer: Multiplan Commercial |
$408.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.55
|
| Rate for Payer: United Healthcare Commercial |
$417.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.55
|
| Rate for Payer: United Healthcare VA CCN |
$197.55
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$846.92
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
4502567501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$626.81 |
| 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 |
$626.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.54
|
| 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: Multiplan Commercial |
$787.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.88
|
| Rate for Payer: United Healthcare Commercial |
$804.57
|
|
