|
CLTX GR HMRL TBRS FX WO MNPJ
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$726.04 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Aetna of VT Commercial |
$931.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$726.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$726.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$833.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$824.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$784.80
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$784.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$784.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$784.80
|
| Rate for Payer: Multiplan Commercial |
$912.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$833.85
|
| Rate for Payer: United Healthcare Commercial |
$931.95
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$519.55 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of VT Commercial |
$666.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$589.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.60
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.70
|
| Rate for Payer: United Healthcare Commercial |
$666.90
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.92 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna of VT Commercial |
$666.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$310.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$422.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$568.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$315.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$558.09
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.90
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$315.90
|
| Rate for Payer: United Healthcare Commercial |
$666.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.90
|
| Rate for Payer: United Healthcare VA CCN |
$315.90
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$257.89 |
| Max. Negotiated Rate |
$659.88 |
| Rate for Payer: Aetna of VT Commercial |
$659.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.93
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$486.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.77
|
| Rate for Payer: Multiplan Commercial |
$652.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare Commercial |
$396.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare VA CCN |
$257.89
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Aetna of VT Commercial |
$931.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$878.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$434.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$878.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$590.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$833.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$794.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$441.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$779.89
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$784.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$784.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$784.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$441.45
|
| Rate for Payer: Multiplan Commercial |
$912.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$833.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$441.45
|
| Rate for Payer: United Healthcare Commercial |
$931.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$441.45
|
| Rate for Payer: United Healthcare VA CCN |
$441.45
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
5102362001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.85 |
| Max. Negotiated Rate |
$486.69 |
| Rate for Payer: Aetna of VT Commercial |
$263.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.93
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$486.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.77
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare Commercial |
$396.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare VA CCN |
$257.89
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
9602362001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$257.89 |
| Max. Negotiated Rate |
$922.14 |
| Rate for Payer: Aetna of VT Commercial |
$922.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$878.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$878.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.93
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$486.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.77
|
| Rate for Payer: Multiplan Commercial |
$912.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare Commercial |
$396.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.89
|
| Rate for Payer: United Healthcare VA CCN |
$257.89
|
|
|
CLTX GR HMRL TBRS FX WO MNPJ
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
5102362001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.23 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$523.06 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$523.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$710.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$956.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$531.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$938.89
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$531.45
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$531.45
|
| Rate for Payer: United Healthcare Commercial |
$1,121.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$531.45
|
| Rate for Payer: United Healthcare VA CCN |
$531.45
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$1,110.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,110.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$435.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$592.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$486.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.13
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$807.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$778.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$778.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare Commercial |
$650.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare VA CCN |
$423.10
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9822776201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$1,110.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,110.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$435.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$592.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$486.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.13
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$807.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$778.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$778.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare Commercial |
$650.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare VA CCN |
$423.10
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9822776201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$523.06 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$523.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$710.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$956.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$531.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$938.89
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$531.45
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$531.45
|
| Rate for Payer: United Healthcare Commercial |
$1,121.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$531.45
|
| Rate for Payer: United Healthcare VA CCN |
$531.45
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9822776201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$874.06 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$992.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$944.80
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.80
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.85
|
| Rate for Payer: United Healthcare Commercial |
$1,121.95
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1,181.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$874.06 |
| Max. Negotiated Rate |
$1,121.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$992.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$944.80
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.80
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.85
|
| Rate for Payer: United Healthcare Commercial |
$1,121.95
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
9812776201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$807.67 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$435.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$592.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$486.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.13
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$807.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$778.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$778.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare Commercial |
$650.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$423.10
|
| Rate for Payer: United Healthcare VA CCN |
$423.10
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1,921.17
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
4502776201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$850.89 |
| Max. Negotiated Rate |
$1,825.11 |
| Rate for Payer: Aetna of VT Commercial |
$1,825.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,721.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$850.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,721.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,156.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,632.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,556.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$864.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,527.33
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cigna Commercial |
$1,536.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,536.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,536.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$864.53
|
| Rate for Payer: Multiplan Commercial |
$1,786.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,632.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$864.53
|
| Rate for Payer: United Healthcare Commercial |
$1,825.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$864.53
|
| Rate for Payer: United Healthcare VA CCN |
$864.53
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1,921.17
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
4502776201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,421.86 |
| Max. Negotiated Rate |
$1,825.11 |
| Rate for Payer: Aetna of VT Commercial |
$1,825.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,421.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,421.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,632.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,613.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,536.94
|
| Rate for Payer: Cash Price |
$960.58
|
| Rate for Payer: Cigna Commercial |
$1,536.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,536.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,536.94
|
| Rate for Payer: Multiplan Commercial |
$1,786.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,632.99
|
| Rate for Payer: United Healthcare Commercial |
$1,825.11
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9822776001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9812776001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9602776001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.54 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Aetna of VT Commercial |
$623.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$587.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$290.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$587.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$394.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$557.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$521.52
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cigna Commercial |
$524.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$524.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$524.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$295.20
|
| Rate for Payer: Multiplan Commercial |
$610.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$557.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare Commercial |
$623.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.20
|
| Rate for Payer: United Healthcare VA CCN |
$295.20
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9602776001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$485.51 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Aetna of VT Commercial |
$623.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$485.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$485.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$557.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$551.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$524.80
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cigna Commercial |
$524.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$524.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$524.80
|
| Rate for Payer: Multiplan Commercial |
$610.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$557.60
|
| Rate for Payer: United Healthcare Commercial |
$623.20
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
5102776001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.09 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna of VT Commercial |
$303.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.20
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.20
|
| Rate for Payer: Multiplan Commercial |
$296.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.15
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
|
|
CLTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9812776002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$301.92 |
| Max. Negotiated Rate |
$575.15 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$426.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$473.29
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$575.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$331.00
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$304.66
|
| Rate for Payer: United Healthcare Commercial |
$468.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.66
|
| Rate for Payer: United Healthcare VA CCN |
$304.66
|
|
