|
OPIOIDS & OPIATE ANALOGS 1/2
|
Professional
|
Both
|
$29.31
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
3008036201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna of VT Commercial |
$27.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.39
|
| Rate for Payer: Multiplan Commercial |
$27.26
|
| Rate for Payer: United Healthcare Commercial |
$24.91
|
| Rate for Payer: United Healthcare VA CCN |
$11.72
|
|
|
OPIOIDS & OPIATE ANALOGS 1/2
|
Facility
|
OP
|
$29.31
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
3008036201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$27.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.30
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cigna Commercial |
$23.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$27.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$13.19
|
|
|
OPTIFLOW CANNULA LARGE
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
2700049531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.60
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
|
|
OPTIFLOW CANNULA LARGE
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
2700049531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.57
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare VA CCN |
$2.59
|
|
|
OPTIFLOW CANNULA MED
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
2700049521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.60
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
|
|
OPTIFLOW CANNULA MED
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
2700049521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.57
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare VA CCN |
$2.59
|
|
|
OPTIFLOW CANNULA SMALL
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
2700049511
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.57
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.59
|
| Rate for Payer: United Healthcare VA CCN |
$2.59
|
|
|
OPTIFLOW CANNULA SMALL
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
2700049511
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$5.46 |
| Rate for Payer: Aetna of VT Commercial |
$5.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.60
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$5.46
|
|
|
OPTISON 18X3ML
|
Facility
|
IP
|
$402.74
|
|
| Hospital Charge Code |
2550059471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.07 |
| Max. Negotiated Rate |
$382.60 |
| Rate for Payer: Aetna of VT Commercial |
$382.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$322.19
|
| Rate for Payer: Cash Price |
$201.37
|
| Rate for Payer: Cigna Commercial |
$322.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.19
|
| Rate for Payer: Multiplan Commercial |
$374.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.33
|
| Rate for Payer: United Healthcare Commercial |
$382.60
|
|
|
OPTISON 18X3ML
|
Facility
|
OP
|
$402.74
|
|
| Hospital Charge Code |
2550059471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.37 |
| Max. Negotiated Rate |
$382.60 |
| Rate for Payer: Aetna of VT Commercial |
$382.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$360.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$360.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$242.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$181.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$320.18
|
| Rate for Payer: Cash Price |
$201.37
|
| Rate for Payer: Cigna Commercial |
$322.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$181.23
|
| Rate for Payer: Multiplan Commercial |
$374.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.23
|
| Rate for Payer: United Healthcare Commercial |
$382.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.23
|
| Rate for Payer: United Healthcare VA CCN |
$181.23
|
|
|
OPTX CLAVICULAR FX W/INT FIX
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
9822351501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$683.02 |
| Max. Negotiated Rate |
$1,900.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,900.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,811.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$703.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,811.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$956.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$934.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$934.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$785.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$934.52
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,293.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,137.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,137.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$683.02
|
| Rate for Payer: Multiplan Commercial |
$1,880.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$969.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$683.02
|
| Rate for Payer: United Healthcare Commercial |
$1,050.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.02
|
| Rate for Payer: United Healthcare VA CCN |
$683.02
|
|
|
OPTX CLAVICULAR FX W/INT FIX
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
9822351501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,496.48 |
| Max. Negotiated Rate |
$1,920.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,920.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,496.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,496.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,698.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,617.60
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,617.60
|
| Rate for Payer: Multiplan Commercial |
$1,880.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.70
|
| Rate for Payer: United Healthcare Commercial |
$1,920.90
|
|
|
OPTX CLAVICULAR FX W/INT FIX
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
9822351501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$895.54 |
| Max. Negotiated Rate |
$1,920.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,920.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,811.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$895.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,811.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,217.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,637.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$909.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,607.49
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,617.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$909.90
|
| Rate for Payer: Multiplan Commercial |
$1,880.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,718.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$909.90
|
| Rate for Payer: United Healthcare Commercial |
$1,920.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$909.90
|
| Rate for Payer: United Healthcare VA CCN |
$909.90
|
|
|
OPTX GR HMRL TBRS FX INT FIX
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
9822363001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$924.78 |
| Max. Negotiated Rate |
$1,983.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,983.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,870.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$924.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,870.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,256.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,774.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,691.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$939.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,659.96
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,670.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,670.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,670.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$939.60
|
| Rate for Payer: Multiplan Commercial |
$1,941.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,774.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$939.60
|
| Rate for Payer: United Healthcare Commercial |
$1,983.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$939.60
|
| Rate for Payer: United Healthcare VA CCN |
$939.60
|
|
|
OPTX GR HMRL TBRS FX INT FIX
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
9822363001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,545.33 |
| Max. Negotiated Rate |
$1,983.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,983.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,545.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,545.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,774.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,753.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,670.40
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,670.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,670.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,670.40
|
| Rate for Payer: Multiplan Commercial |
$1,941.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,774.80
|
| Rate for Payer: United Healthcare Commercial |
$1,983.60
|
|
|
OPTX GR HMRL TBRS FX INT FIX
|
Professional
|
Both
|
$2,088.00
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
9822363001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$740.21 |
| Max. Negotiated Rate |
$1,962.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,962.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,870.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$762.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,870.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,036.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,059.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,059.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$851.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,059.85
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna Commercial |
$1,400.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,233.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,233.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$740.21
|
| Rate for Payer: Multiplan Commercial |
$1,941.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,051.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$740.21
|
| Rate for Payer: United Healthcare Commercial |
$1,138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$740.21
|
| Rate for Payer: United Healthcare VA CCN |
$740.21
|
|
|
OPTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
CPT 27766
|
| Hospital Charge Code |
9822776601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$576.63 |
| Max. Negotiated Rate |
$1,467.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,467.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$807.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,159.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,159.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,159.34
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,090.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$956.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$956.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$576.63
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$818.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$576.63
|
| Rate for Payer: United Healthcare Commercial |
$887.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$576.63
|
| Rate for Payer: United Healthcare VA CCN |
$576.63
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 27766
|
| Hospital Charge Code |
9822776601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$691.37 |
| Max. Negotiated Rate |
$1,482.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$691.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,398.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$939.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,264.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$702.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,240.99
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$702.45
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$702.45
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$702.45
|
| Rate for Payer: United Healthcare VA CCN |
$702.45
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 27766
|
| Hospital Charge Code |
9822776601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,155.30 |
| Max. Negotiated Rate |
$1,482.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,155.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,155.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,311.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,248.80
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,248.80
|
| Rate for Payer: Multiplan Commercial |
$1,451.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,326.85
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
|
|
OPTX PROX HUMRL FX W/INT FIX
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
9822361501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$961.98 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,063.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,945.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$961.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,945.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,307.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,846.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,759.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$977.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,726.74
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,737.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$977.40
|
| Rate for Payer: Multiplan Commercial |
$2,019.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,846.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$977.40
|
| Rate for Payer: United Healthcare Commercial |
$2,063.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$977.40
|
| Rate for Payer: United Healthcare VA CCN |
$977.40
|
|
|
OPTX PROX HUMRL FX W/INT FIX
|
Professional
|
Both
|
$2,172.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
9822361501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$833.18 |
| Max. Negotiated Rate |
$2,041.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,041.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,945.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$858.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,945.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,166.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,163.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,163.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$958.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,163.76
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,577.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,389.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,389.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$833.18
|
| Rate for Payer: Multiplan Commercial |
$2,019.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,183.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$833.18
|
| Rate for Payer: United Healthcare Commercial |
$1,281.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$833.18
|
| Rate for Payer: United Healthcare VA CCN |
$833.18
|
|
|
OPTX PROX HUMRL FX W/INT FIX
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
9822361501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,607.50 |
| Max. Negotiated Rate |
$2,063.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,063.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,607.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,607.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,846.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,824.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,737.60
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,737.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,737.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,846.20
|
| Rate for Payer: United Healthcare Commercial |
$2,063.40
|
|
|
OPTX SCAPULAR FX W/INT FIXJ
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
CPT 23585
|
| Hospital Charge Code |
9822358501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,000.49 |
| Max. Negotiated Rate |
$2,567.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,567.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,000.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,000.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,297.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,270.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,162.40
|
| Rate for Payer: Cash Price |
$1,351.50
|
| Rate for Payer: Cigna Commercial |
$2,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,162.40
|
| Rate for Payer: Multiplan Commercial |
$2,513.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,297.55
|
| Rate for Payer: United Healthcare Commercial |
$2,567.85
|
|
|
OPTX SCAPULAR FX W/INT FIXJ
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
CPT 23585
|
| Hospital Charge Code |
9822358501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,197.16 |
| Max. Negotiated Rate |
$2,567.85 |
| Rate for Payer: Aetna of VT Commercial |
$2,567.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,421.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,197.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,421.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,627.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,297.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,189.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,216.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,148.89
|
| Rate for Payer: Cash Price |
$1,351.50
|
| Rate for Payer: Cigna Commercial |
$2,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,162.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,216.35
|
| Rate for Payer: Multiplan Commercial |
$2,513.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,297.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,216.35
|
| Rate for Payer: United Healthcare Commercial |
$2,567.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,216.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,216.35
|
|
|
OPTX SCAPULAR FX W/INT FIXJ
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
CPT 23585
|
| Hospital Charge Code |
9822358501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$915.44 |
| Max. Negotiated Rate |
$2,540.82 |
| Rate for Payer: Aetna of VT Commercial |
$2,540.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,421.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$942.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,421.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,281.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,285.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,052.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.43
|
| Rate for Payer: Cash Price |
$1,351.50
|
| Rate for Payer: Cash Price |
$1,351.50
|
| Rate for Payer: Cigna Commercial |
$1,734.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,529.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,529.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$915.44
|
| Rate for Payer: Multiplan Commercial |
$2,513.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,299.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$915.44
|
| Rate for Payer: United Healthcare Commercial |
$1,408.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$915.44
|
| Rate for Payer: United Healthcare VA CCN |
$915.44
|
|
