|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.62
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare VA CCN |
$213.75
|
|
|
TREAT WRIST FRACTURE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$425.55 |
| Max. Negotiated Rate |
$969.94 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$528.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$718.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.52
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$969.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.33
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare Commercial |
$789.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare VA CCN |
$513.33
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$351.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
5102568001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.49 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Aetna of VT Commercial |
$648.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.40
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.40
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
|
|
TREAT WRIST FRACTURE
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
5102568001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$513.33 |
| Max. Negotiated Rate |
$969.94 |
| 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 |
$528.73
|
| 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 |
$718.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.52
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$969.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.33
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare Commercial |
$789.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare VA CCN |
$513.33
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.62
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.75
|
| Rate for Payer: United Healthcare VA CCN |
$213.75
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568001
|
|
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 FRACTURE
|
Facility
|
OP
|
$682.96
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
4502568001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.48 |
| Max. Negotiated Rate |
$648.81 |
| Rate for Payer: Aetna of VT Commercial |
$648.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$553.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.95
|
| Rate for Payer: Cash Price |
$341.48
|
| Rate for Payer: Cigna Commercial |
$546.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$307.33
|
| Rate for Payer: Multiplan Commercial |
$635.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.33
|
| Rate for Payer: United Healthcare Commercial |
$648.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.33
|
| Rate for Payer: United Healthcare VA CCN |
$307.33
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568001
|
|
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 FRACTURE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$351.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna of VT Commercial |
$451.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.00
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$451.25
|
|
|
TREAT WRIST FRACTURE
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$513.33 |
| Max. Negotiated Rate |
$1,088.52 |
| Rate for Payer: Aetna of VT Commercial |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$528.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$718.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.52
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$969.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.33
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare Commercial |
$789.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare VA CCN |
$513.33
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$857.04 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$857.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$857.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$984.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$972.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$926.40
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.40
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$984.30
|
| Rate for Payer: United Healthcare Commercial |
$1,100.10
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
5102568001
|
|
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 FRACTURE
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9602568001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$512.88 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,100.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$512.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,037.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$697.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$984.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$937.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$920.61
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$521.10
|
| Rate for Payer: Multiplan Commercial |
$1,076.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$984.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$521.10
|
| Rate for Payer: United Healthcare Commercial |
$1,100.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$521.10
|
| Rate for Payer: United Healthcare VA CCN |
$521.10
|
|
|
TREAT WRIST FRACTURE
|
Facility
|
IP
|
$682.96
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
4502568001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.46 |
| Max. Negotiated Rate |
$648.81 |
| Rate for Payer: Aetna of VT Commercial |
$648.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.37
|
| Rate for Payer: Cash Price |
$341.48
|
| Rate for Payer: Cigna Commercial |
$546.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.37
|
| Rate for Payer: Multiplan Commercial |
$635.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.52
|
| Rate for Payer: United Healthcare Commercial |
$648.81
|
|
|
TREAT WRIST FRACTURE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$425.55 |
| Max. Negotiated Rate |
$969.94 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$528.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$718.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.52
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$969.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.33
|
| Rate for Payer: Multiplan Commercial |
$441.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare Commercial |
$789.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare VA CCN |
$513.33
|
|
|
TREAT WRIST FRACTURE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
9812568001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$969.94 |
| 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 |
$528.73
|
| 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 |
$718.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$590.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.52
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$969.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$851.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$851.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.33
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$728.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare Commercial |
$789.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.33
|
| Rate for Payer: United Healthcare VA CCN |
$513.33
|
|
|
TRIAMCINOLONE 0.1% CREAM
|
Professional
|
Both
|
$0.01
|
|
| Hospital Charge Code |
2500000293
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
TRIAMCINOLONE 0.1% CREAM
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
NDC 4580206435
|
| Hospital Charge Code |
2500000293
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
TRIAMCINOLONE ACET 200 MG/5 ML
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.39
|
|
|
TRIAMCINOLONE ACET 200 MG/5 ML
|
Professional
|
Both
|
$24.57
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna of VT Commercial |
$23.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Cash Price |
$12.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$22.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare VA CCN |
$0.84
|
|
|
TRIAMCINOLONE ACET 400 MG/10ML
|
Facility
|
IP
|
$29.90
|
|
|
Service Code
|
NDC 1671415001
|
| Hospital Charge Code |
636J330103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna of VT Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.92
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.41
|
| Rate for Payer: United Healthcare Commercial |
$28.41
|
|
|
TRIAMCINOLONE ACET 400 MG/10ML
|
Professional
|
Both
|
$29.90
|
|
|
Service Code
|
NDC 1671415001
|
| Hospital Charge Code |
636J330103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Aetna of VT Commercial |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.79
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: United Healthcare Commercial |
$25.41
|
| Rate for Payer: United Healthcare VA CCN |
$11.96
|
|
|
TRIAMCINOLONE ACET 400 MG/10ML
|
Facility
|
OP
|
$29.90
|
|
|
Service Code
|
NDC 1671415001
|
| Hospital Charge Code |
636J330103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna of VT Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.77
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.46
|
| Rate for Payer: Multiplan Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$28.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.46
|
| Rate for Payer: United Healthcare VA CCN |
$13.46
|
|
|
TRIAMCINOLONE ACET 40 MG/ML
|
Facility
|
IP
|
$9.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of VT Commercial |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.35
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cigna Commercial |
$7.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.35
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.81
|
| Rate for Payer: United Healthcare Commercial |
$8.73
|
|
