|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$318.47
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
4502776001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$302.55 |
| Rate for Payer: Aetna of VT Commercial |
$302.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$285.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.18
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cigna Commercial |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.31
|
| Rate for Payer: Multiplan Commercial |
$296.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.31
|
| Rate for Payer: United Healthcare Commercial |
$302.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.31
|
| Rate for Payer: United Healthcare VA CCN |
$143.31
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9812776002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.26 |
| 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 |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| 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 |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| 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: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9822776001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$149.26 |
| 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 |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| 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 |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| 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: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
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
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9602776002
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9602776002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
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
|
$1.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9812776001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$575.15 |
| 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 |
$313.80
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9812776002
|
|
Hospital Revenue Code
|
981
|
| 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
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
5102776001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$285.79 |
| Max. Negotiated Rate |
$575.15 |
| Rate for Payer: Aetna of VT Commercial |
$299.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$285.79
|
| 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 |
$285.79
|
| 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 |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| 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 |
$296.67
|
| 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
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9602776002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$149.26 |
| 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 |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| 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 |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| 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: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$318.47
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
4502776001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.70 |
| Max. Negotiated Rate |
$302.55 |
| Rate for Payer: Aetna of VT Commercial |
$302.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$267.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.78
|
| Rate for Payer: Cash Price |
$159.24
|
| Rate for Payer: Cigna Commercial |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$254.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$254.78
|
| Rate for Payer: Multiplan Commercial |
$296.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$270.70
|
| Rate for Payer: United Healthcare Commercial |
$302.55
|
|
|
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
|
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
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.20
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
OP
|
$1,233.05
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
4502847501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$546.12 |
| Max. Negotiated Rate |
$1,171.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,171.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,104.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$546.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,104.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$742.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,048.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$998.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$554.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$980.27
|
| Rate for Payer: Cash Price |
$616.52
|
| Rate for Payer: Cigna Commercial |
$986.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$986.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$986.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$554.87
|
| Rate for Payer: Multiplan Commercial |
$1,146.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,048.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$554.87
|
| Rate for Payer: United Healthcare Commercial |
$1,171.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$554.87
|
| Rate for Payer: United Healthcare VA CCN |
$554.87
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847501
|
|
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 METAR FX W/MANJ
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$460.74 |
| 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 |
$230.91
|
| 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 |
$313.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.74
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$425.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$255.34
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare Commercial |
$344.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare VA CCN |
$224.18
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$298.51 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.83
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$303.30
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare VA CCN |
$303.30
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847501
|
|
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 METAR FX W/MANJ
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9822847501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$224.18 |
| Max. Negotiated Rate |
$633.56 |
| Rate for Payer: Aetna of VT Commercial |
$633.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.74
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$425.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$255.34
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare Commercial |
$344.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare VA CCN |
$224.18
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9822847501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$298.51 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.83
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$303.30
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare VA CCN |
$303.30
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9822847501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.20
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
|
|
CLTX METAR FX W/MANJ
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
9812847502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$224.18 |
| Max. Negotiated Rate |
$633.56 |
| Rate for Payer: Aetna of VT Commercial |
$633.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$257.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.74
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$425.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$255.34
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare Commercial |
$344.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$224.18
|
| Rate for Payer: United Healthcare VA CCN |
$224.18
|
|
|
CLTX METAR FX W/MANJ
|
Facility
|
IP
|
$1,233.05
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
4502847501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$912.58 |
| Max. Negotiated Rate |
$1,171.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,171.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$912.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$912.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,048.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,035.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$986.44
|
| Rate for Payer: Cash Price |
$616.52
|
| Rate for Payer: Cigna Commercial |
$986.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$986.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$986.44
|
| Rate for Payer: Multiplan Commercial |
$1,146.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,048.09
|
| Rate for Payer: United Healthcare Commercial |
$1,171.40
|
|
