|
SPH TIB INS ECROSS CR 4R 12MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067041
|
|
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 13MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067051
|
|
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 13MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067051
|
|
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 14MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067061
|
|
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 14MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067061
|
|
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 6L 10MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067081
|
|
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 6L 10MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067081
|
|
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 6L 12MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067101
|
|
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 6L 12MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067101
|
|
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 6L 13MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067111
|
|
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 6L 13MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067111
|
|
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 6L 14MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067121
|
|
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 6L 14MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067121
|
|
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 6L 1MM
|
Facility
|
IP
|
$0.03
|
|
| Hospital Charge Code |
2780067091
|
|
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 6L 1MM
|
Facility
|
OP
|
$0.03
|
|
| Hospital Charge Code |
2780067091
|
|
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
|
|
|
SR LUMBSCRL ONLY BEND 2/3 VWS
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 72120 26
|
| Hospital Charge Code |
9727212001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$129.86 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.24
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$15.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare VA CCN |
$10.17
|
|
|
SR LUMBSCRL ONLY BEND 2/3 VWS
|
Facility
|
IP
|
$773.67
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
3207212001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$572.59 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna of VT Commercial |
$734.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$572.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$572.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$649.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$618.94
|
| Rate for Payer: Cash Price |
$386.84
|
| Rate for Payer: Cigna Commercial |
$618.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.94
|
| Rate for Payer: Multiplan Commercial |
$719.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.62
|
| Rate for Payer: United Healthcare Commercial |
$734.99
|
|
|
SR LUMBSCRL ONLY BEND 2/3 VWS
|
Facility
|
OP
|
$773.67
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
3207212001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.86 |
| Max. Negotiated Rate |
$734.99 |
| Rate for Payer: Aetna of VT Commercial |
$734.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$342.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$626.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$615.07
|
| Rate for Payer: Cash Price |
$386.84
|
| Rate for Payer: Cash Price |
$386.84
|
| Rate for Payer: Cigna Commercial |
$618.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.15
|
| Rate for Payer: Multiplan Commercial |
$719.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$348.15
|
| Rate for Payer: United Healthcare Commercial |
$734.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.15
|
| Rate for Payer: United Healthcare VA CCN |
$348.15
|
|
|
SR LUMBSCRL ONLY BEND 2/3 VWS
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 72120 26
|
| Hospital Charge Code |
9727212001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.95 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
|
|
SR LUMBSCRL ONLY BEND 2/3 VWS
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 72120 26
|
| Hospital Charge Code |
9727212001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.14
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare VA CCN |
$58.95
|
|
|
STAPLE NIT STRT SYSTEM 18X18X1
|
Facility
|
OP
|
$2,834.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.27 |
| Max. Negotiated Rate |
$2,692.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,692.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,539.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,255.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,539.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,706.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,295.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,275.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,253.20
|
| Rate for Payer: Cash Price |
$1,417.11
|
| Rate for Payer: Cigna Commercial |
$2,267.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,267.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,267.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,275.39
|
| Rate for Payer: Multiplan Commercial |
$2,635.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,409.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,275.39
|
| Rate for Payer: United Healthcare Commercial |
$2,692.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,275.39
|
| Rate for Payer: United Healthcare VA CCN |
$1,275.39
|
|
|
STAPLE NIT STRT SYSTEM 18X18X1
|
Facility
|
IP
|
$2,834.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780074281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.60 |
| Max. Negotiated Rate |
$2,692.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,692.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,380.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,267.37
|
| Rate for Payer: Cash Price |
$1,417.11
|
| Rate for Payer: Cigna Commercial |
$2,267.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,267.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,267.37
|
| Rate for Payer: Multiplan Commercial |
$2,635.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,409.08
|
| Rate for Payer: United Healthcare Commercial |
$2,692.50
|
|
|
STEREO BXDEVICE PETITE
|
Facility
|
IP
|
$1,113.16
|
|
| Hospital Charge Code |
2720023301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.85 |
| Max. Negotiated Rate |
$1,057.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,057.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$823.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$823.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$946.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$935.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$890.53
|
| Rate for Payer: Cash Price |
$556.58
|
| Rate for Payer: Cigna Commercial |
$890.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$890.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$890.53
|
| Rate for Payer: Multiplan Commercial |
$1,035.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$946.19
|
| Rate for Payer: United Healthcare Commercial |
$1,057.50
|
|
|
STEREO BXDEVICE PETITE
|
Facility
|
OP
|
$1,113.16
|
|
| Hospital Charge Code |
2720023301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.02 |
| Max. Negotiated Rate |
$1,057.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,057.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$997.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$493.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$997.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$670.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$946.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$901.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$500.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$884.96
|
| Rate for Payer: Cash Price |
$556.58
|
| Rate for Payer: Cigna Commercial |
$890.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$890.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$890.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$500.92
|
| Rate for Payer: Multiplan Commercial |
$1,035.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$946.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$500.92
|
| Rate for Payer: United Healthcare Commercial |
$1,057.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$500.92
|
| Rate for Payer: United Healthcare VA CCN |
$500.92
|
|
|
STEREO BX DEVICE STD
|
Facility
|
IP
|
$1,113.24
|
|
| Hospital Charge Code |
2720023311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.91 |
| Max. Negotiated Rate |
$1,057.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,057.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$823.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$823.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$946.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$935.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$890.59
|
| Rate for Payer: Cash Price |
$556.62
|
| Rate for Payer: Cigna Commercial |
$890.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$890.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$890.59
|
| Rate for Payer: Multiplan Commercial |
$1,035.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$946.25
|
| Rate for Payer: United Healthcare Commercial |
$1,057.58
|
|
