|
TRIAMCINOLONE ACET 40 MG/ML
|
Professional
|
Both
|
$9.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna of VT Commercial |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.84
|
| Rate for Payer: United Healthcare VA CCN |
$0.84
|
|
|
TRIAMCINOLONE ACET 40 MG/ML
|
Facility
|
OP
|
$9.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of VT Commercial |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.31
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cigna Commercial |
$7.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$8.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.14
|
| Rate for Payer: United Healthcare Commercial |
$8.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.14
|
| Rate for Payer: United Healthcare VA CCN |
$4.14
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Professional
|
Both
|
$101.33
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
3008766101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$95.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.60
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$94.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Facility
|
IP
|
$101.33
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
3008766101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$96.26 |
| Rate for Payer: Aetna of VT Commercial |
$96.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.06
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cigna Commercial |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.06
|
| Rate for Payer: Multiplan Commercial |
$94.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.13
|
| Rate for Payer: United Healthcare Commercial |
$96.26
|
|
|
TRICHOMONAS VAGINALIS AMPLIF
|
Facility
|
OP
|
$101.33
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
3008766101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$96.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.56
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cigna Commercial |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$94.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$96.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$45.60
|
|
|
TRIIODOTHYRONINE T3 REVERSE
|
Facility
|
OP
|
$215.90
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
3008448201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna of VT Commercial |
$205.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.64
|
| Rate for Payer: Cash Price |
$107.95
|
| Rate for Payer: Cash Price |
$107.95
|
| Rate for Payer: Cigna Commercial |
$172.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.16
|
| Rate for Payer: Multiplan Commercial |
$200.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.16
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.76
|
| Rate for Payer: United Healthcare VA CCN |
$97.16
|
|
|
TRIIODOTHYRONINE T3 REVERSE
|
Professional
|
Both
|
$215.90
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
3008448201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$202.95 |
| Rate for Payer: Aetna of VT Commercial |
$202.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.94
|
| Rate for Payer: Cash Price |
$107.95
|
| Rate for Payer: Cash Price |
$107.95
|
| Rate for Payer: Cigna Commercial |
$19.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.54
|
| Rate for Payer: Multiplan Commercial |
$200.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.76
|
| Rate for Payer: United Healthcare Commercial |
$24.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.76
|
| Rate for Payer: United Healthcare VA CCN |
$15.76
|
|
|
TRIIODOTHYRONINE T3 REVERSE
|
Facility
|
IP
|
$215.90
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
3008448201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna of VT Commercial |
$205.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.72
|
| Rate for Payer: Cash Price |
$107.95
|
| Rate for Payer: Cigna Commercial |
$172.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.72
|
| Rate for Payer: Multiplan Commercial |
$200.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.51
|
| Rate for Payer: United Healthcare Commercial |
$205.10
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$637.23 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.80
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9822781601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$637.23 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.80
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.19 |
| Max. Negotiated Rate |
$809.34 |
| Rate for Payer: Aetna of VT Commercial |
$809.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.95
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.78
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare Commercial |
$446.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare VA CCN |
$290.19
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
5102781601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$521.03 |
| Max. Negotiated Rate |
$668.80 |
| Rate for Payer: Aetna of VT Commercial |
$668.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$521.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$521.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$598.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$591.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$563.20
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$563.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$563.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$563.20
|
| Rate for Payer: Multiplan Commercial |
$654.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$598.40
|
| Rate for Payer: United Healthcare Commercial |
$668.80
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$381.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$518.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$697.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.45
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare VA CCN |
$387.45
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.19 |
| Max. Negotiated Rate |
$1,470.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,470.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,401.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,401.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.95
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.78
|
| Rate for Payer: Multiplan Commercial |
$1,454.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare Commercial |
$446.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare VA CCN |
$290.19
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$692.70 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,485.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,401.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$692.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,401.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$941.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,329.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,266.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$703.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,243.38
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,251.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,251.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$703.80
|
| Rate for Payer: Multiplan Commercial |
$1,454.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,329.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$703.80
|
| Rate for Payer: United Healthcare Commercial |
$1,485.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$703.80
|
| Rate for Payer: United Healthcare VA CCN |
$703.80
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9602781601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,157.52 |
| Max. Negotiated Rate |
$1,485.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,485.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,157.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,157.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,329.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,313.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,251.20
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,251.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,251.20
|
| Rate for Payer: Multiplan Commercial |
$1,454.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,329.40
|
| Rate for Payer: United Healthcare Commercial |
$1,485.80
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
5102781601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$290.19 |
| Max. Negotiated Rate |
$661.76 |
| Rate for Payer: Aetna of VT Commercial |
$661.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$630.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$630.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.95
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.78
|
| Rate for Payer: Multiplan Commercial |
$654.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare Commercial |
$446.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare VA CCN |
$290.19
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
5102781601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.80 |
| Max. Negotiated Rate |
$668.80 |
| Rate for Payer: Aetna of VT Commercial |
$668.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$630.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$311.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$630.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$423.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$598.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$316.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$559.68
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$563.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$563.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$563.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$316.80
|
| Rate for Payer: Multiplan Commercial |
$654.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$598.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$316.80
|
| Rate for Payer: United Healthcare Commercial |
$668.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.80
|
| Rate for Payer: United Healthcare VA CCN |
$316.80
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9822781601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$290.19 |
| Max. Negotiated Rate |
$809.34 |
| Rate for Payer: Aetna of VT Commercial |
$809.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.95
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.78
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare Commercial |
$446.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.19
|
| Rate for Payer: United Healthcare VA CCN |
$290.19
|
|
|
TRIMALLEOLAR ANKLE FX W/O MAN
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9822781601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$381.34 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna of VT Commercial |
$817.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$381.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$518.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$697.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$387.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$688.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$688.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$387.45
|
| Rate for Payer: Multiplan Commercial |
$800.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$731.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare Commercial |
$817.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.45
|
| Rate for Payer: United Healthcare VA CCN |
$387.45
|
|
|
TRIM NAIL(S)
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
TRIM NAIL(S)
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
TRIM NAIL(S)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.47
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.70
|
| Rate for Payer: United Healthcare VA CCN |
$29.70
|
|
|
TRIM NAIL(S)
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
510G012701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$122.74 |
| Rate for Payer: Aetna of VT Commercial |
$76.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.14
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.01
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NAIL(S)
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
510G012701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.80
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
|
