|
SPECTRUM SU LOPRO S3 (SW)
|
Facility
|
OP
|
$42.39
|
|
| Hospital Charge Code |
2720053181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.70
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare VA CCN |
$19.08
|
|
|
SPECTRUM SU LOPRO S3 (SW)
|
Professional
|
Both
|
$42.39
|
|
| Hospital Charge Code |
2720053181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna of VT Commercial |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare VA CCN |
$16.96
|
|
|
SPECTRUM SU LOPRO S3 (SW)
|
Facility
|
IP
|
$42.39
|
|
| Hospital Charge Code |
2720053181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
SPECTRUM SU LOPRO S4 (SW)
|
Professional
|
Both
|
$42.39
|
|
| Hospital Charge Code |
2720053191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna of VT Commercial |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare VA CCN |
$16.96
|
|
|
SPECTRUM SU LOPRO S4 (SW)
|
Facility
|
IP
|
$42.39
|
|
| Hospital Charge Code |
2720053191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
SPECTRUM SU LOPRO S4 (SW)
|
Facility
|
OP
|
$42.39
|
|
| Hospital Charge Code |
2720053191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.70
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare VA CCN |
$19.08
|
|
|
SPECTRUM SU MILLER S0
|
Facility
|
IP
|
$54.80
|
|
| Hospital Charge Code |
2720055611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.84
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
|
|
SPECTRUM SU MILLER S0
|
Professional
|
Both
|
$54.80
|
|
| Hospital Charge Code |
2720055611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$51.51 |
| Rate for Payer: Aetna of VT Commercial |
$51.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.10
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: United Healthcare Commercial |
$46.58
|
| Rate for Payer: United Healthcare VA CCN |
$21.92
|
|
|
SPECTRUM SU MILLER S0
|
Facility
|
OP
|
$54.80
|
|
| Hospital Charge Code |
2720055611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.57
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.66
|
| Rate for Payer: United Healthcare VA CCN |
$24.66
|
|
|
SPECTRUM SU MILLER S1
|
Facility
|
OP
|
$54.80
|
|
| Hospital Charge Code |
2720055621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.57
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.66
|
| Rate for Payer: United Healthcare VA CCN |
$24.66
|
|
|
SPECTRUM SU MILLER S1
|
Facility
|
IP
|
$54.80
|
|
| Hospital Charge Code |
2720055621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.84
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
|
|
SPECTRUM SU MILLER S1
|
Professional
|
Both
|
$54.80
|
|
| Hospital Charge Code |
2720055621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$51.51 |
| Rate for Payer: Aetna of VT Commercial |
$51.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.10
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: United Healthcare Commercial |
$46.58
|
| Rate for Payer: United Healthcare VA CCN |
$21.92
|
|
|
SPEECH/HEARING THERAPY
|
Facility
|
IP
|
$348.08
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
4409250701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$257.61 |
| Max. Negotiated Rate |
$330.68 |
| Rate for Payer: Aetna of VT Commercial |
$330.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.46
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cigna Commercial |
$278.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.46
|
| Rate for Payer: Multiplan Commercial |
$323.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.87
|
| Rate for Payer: United Healthcare Commercial |
$330.68
|
|
|
SPEECH/HEARING THERAPY
|
Facility
|
OP
|
$348.08
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
4409250701
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$154.16 |
| Max. Negotiated Rate |
$330.68 |
| Rate for Payer: Aetna of VT Commercial |
$330.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.72
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cigna Commercial |
$278.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.64
|
| Rate for Payer: Multiplan Commercial |
$323.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.64
|
| Rate for Payer: United Healthcare Commercial |
$330.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.64
|
| Rate for Payer: United Healthcare VA CCN |
$156.64
|
|
|
SPEECH SOUND LANG COMPREHEN
|
Facility
|
OP
|
$546.99
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
4409252301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$242.26 |
| Max. Negotiated Rate |
$519.64 |
| Rate for Payer: Aetna of VT Commercial |
$519.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$490.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$242.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$490.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$329.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$246.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.86
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.15
|
| Rate for Payer: Multiplan Commercial |
$508.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$246.15
|
| Rate for Payer: United Healthcare Commercial |
$519.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.15
|
| Rate for Payer: United Healthcare VA CCN |
$246.15
|
|
|
SPEECH SOUND LANG COMPREHEN
|
Facility
|
IP
|
$546.99
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
4409252301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$404.83 |
| Max. Negotiated Rate |
$519.64 |
| Rate for Payer: Aetna of VT Commercial |
$519.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$459.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$437.59
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.59
|
| Rate for Payer: Multiplan Commercial |
$508.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$464.94
|
| Rate for Payer: United Healthcare Commercial |
$519.64
|
|
|
SPH CR INSERT INSTR SET I6R-T6
|
Facility
|
IP
|
$110.63
|
|
| Hospital Charge Code |
2720073741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.10 |
| Rate for Payer: Aetna of VT Commercial |
$105.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.50
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$102.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.10
|
|
|
SPH CR INSERT INSTR SET I6R-T6
|
Facility
|
OP
|
$110.63
|
|
| Hospital Charge Code |
2720073741
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.10 |
| Rate for Payer: Aetna of VT Commercial |
$105.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.95
|
| Rate for Payer: Cash Price |
$55.31
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.78
|
| Rate for Payer: Multiplan Commercial |
$102.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.78
|
| Rate for Payer: United Healthcare Commercial |
$105.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.78
|
| Rate for Payer: United Healthcare VA CCN |
$49.78
|
|
|
SPHERE FEMUR CEMENTED RIGHT S4
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
SPHERE FEMUR CEMENTED RIGHT S4
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
SPH TIB INS ECROSS CR 4R 10MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
SPH TIB INS ECROSS CR 4R 10MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
SPH TIB INS ECROSS CR 4R 11MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
SPH TIB INS ECROSS CR 4R 11MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
SPH TIB INS ECROSS CR 4R 12MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
