|
CLTX METATARSAL FX W/O MANIP
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$383.98 |
| 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 |
$208.77
|
| 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 |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
CLTX METATARSAL FX W/O MANIP
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.42
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.20
|
| Rate for Payer: United Healthcare VA CCN |
$214.20
|
|
|
CLTX METATARSAL FX W/O MANIP
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna of VT Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.80
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.80
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.60
|
| Rate for Payer: United Healthcare Commercial |
$452.20
|
|
|
CLTX METATARSAL FX W/O MANIP
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$202.69 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Aetna of VT Commercial |
$447.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.82
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna Commercial |
$383.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.90
|
| Rate for Payer: Multiplan Commercial |
$442.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare Commercial |
$311.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.69
|
| Rate for Payer: United Healthcare VA CCN |
$202.69
|
|
|
CLTX METATARSAL FX W/O MANIP
|
Facility
|
OP
|
$303.04
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
4502847001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.22 |
| Max. Negotiated Rate |
$287.89 |
| Rate for Payer: Aetna of VT Commercial |
$287.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$240.92
|
| Rate for Payer: Cash Price |
$151.52
|
| Rate for Payer: Cigna Commercial |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.37
|
| Rate for Payer: Multiplan Commercial |
$281.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.37
|
| Rate for Payer: United Healthcare Commercial |
$287.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.37
|
| Rate for Payer: United Healthcare VA CCN |
$136.37
|
|
|
CLTX METATARSAL FX W/O MANIP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847001
|
|
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 METATARSAL FX W/O MANIP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9812847001
|
|
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 METATARSAL FX W/O MANIP
|
Facility
|
IP
|
$303.04
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
4502847001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.28 |
| Max. Negotiated Rate |
$287.89 |
| Rate for Payer: Aetna of VT Commercial |
$287.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.43
|
| Rate for Payer: Cash Price |
$151.52
|
| Rate for Payer: Cigna Commercial |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.43
|
| Rate for Payer: Multiplan Commercial |
$281.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.58
|
| Rate for Payer: United Healthcare Commercial |
$287.89
|
|
|
CLTX PROX FIBULA/SHFT FX W/MAN
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9822778101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$393.36 |
| Max. Negotiated Rate |
$1,790.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$550.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$727.08
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$744.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$558.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare Commercial |
$605.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare VA CCN |
$393.36
|
|
|
CLTX PROX FIBULA/SHFT FX W/MAN
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9822778101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,409.89 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,809.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,409.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,409.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,619.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,600.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,524.00
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,524.00
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.25
|
| Rate for Payer: United Healthcare Commercial |
$1,809.75
|
|
|
CLTX PROX FIBULA/SHFT FX W/MAN
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9822778101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,809.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$843.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,146.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,619.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,543.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$857.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,514.47
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,524.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$857.25
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$857.25
|
| Rate for Payer: United Healthcare Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$857.25
|
| Rate for Payer: United Healthcare VA CCN |
$857.25
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778101
|
|
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 PROX FIBUL/SHFT FX W/MANJ
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$744.71 |
| 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 |
$405.16
|
| 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 |
$550.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$727.08
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$744.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$558.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare Commercial |
$605.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare VA CCN |
$393.36
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
OP
|
$1,180.62
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
4502778101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.90 |
| Max. Negotiated Rate |
$1,121.59 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,057.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$522.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,057.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$710.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$956.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$531.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$938.59
|
| Rate for Payer: Cash Price |
$590.31
|
| Rate for Payer: Cigna Commercial |
$944.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$531.28
|
| Rate for Payer: Multiplan Commercial |
$1,097.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$531.28
|
| Rate for Payer: United Healthcare Commercial |
$1,121.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$531.28
|
| Rate for Payer: United Healthcare VA CCN |
$531.28
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778101
|
|
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 PROX FIBUL/SHFT FX W/MANJ
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$393.36 |
| Max. Negotiated Rate |
$1,790.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,790.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$550.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$727.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$727.08
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$744.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.38
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$558.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare Commercial |
$605.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.36
|
| Rate for Payer: United Healthcare VA CCN |
$393.36
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,809.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$843.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,706.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,146.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,619.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,543.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$857.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,514.47
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,524.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$857.25
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$857.25
|
| Rate for Payer: United Healthcare Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$857.25
|
| Rate for Payer: United Healthcare VA CCN |
$857.25
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
9812778102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,409.89 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,809.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,409.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,409.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,619.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,600.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,524.00
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,524.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,524.00
|
| Rate for Payer: Multiplan Commercial |
$1,771.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.25
|
| Rate for Payer: United Healthcare Commercial |
$1,809.75
|
|
|
CLTX PROX FIBUL/SHFT FX W/MANJ
|
Facility
|
IP
|
$1,180.62
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
4502778101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$873.78 |
| Max. Negotiated Rate |
$1,121.59 |
| Rate for Payer: Aetna of VT Commercial |
$1,121.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,003.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$991.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$944.50
|
| Rate for Payer: Cash Price |
$590.31
|
| Rate for Payer: Cigna Commercial |
$944.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$944.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$944.50
|
| Rate for Payer: Multiplan Commercial |
$1,097.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,003.53
|
| Rate for Payer: United Healthcare Commercial |
$1,121.59
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5102360501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.79 |
| Max. Negotiated Rate |
$1,084.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,084.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,023.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$505.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,023.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$687.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$970.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$513.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$907.89
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$913.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$913.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$913.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.90
|
| Rate for Payer: Multiplan Commercial |
$1,062.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.90
|
| Rate for Payer: United Healthcare Commercial |
$1,084.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.90
|
| Rate for Payer: United Healthcare VA CCN |
$513.90
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5102360501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$414.12 |
| Max. Negotiated Rate |
$1,073.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,073.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,023.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,023.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$579.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$730.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$730.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$476.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$730.66
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$785.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$757.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$757.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.13
|
| Rate for Payer: Multiplan Commercial |
$1,062.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$588.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$414.12
|
| Rate for Payer: United Healthcare Commercial |
$637.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$414.12
|
| Rate for Payer: United Healthcare VA CCN |
$414.12
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Facility
|
IP
|
$2,208.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
9602360501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,634.14 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,097.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,634.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,634.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,876.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,854.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,766.40
|
| Rate for Payer: Cash Price |
$1,104.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,766.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$2,053.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,876.80
|
| Rate for Payer: United Healthcare Commercial |
$2,097.60
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
9822360501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$414.12 |
| Max. Negotiated Rate |
$1,002.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,002.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$955.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$426.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$955.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$579.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$730.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$730.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$476.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$730.66
|
| Rate for Payer: Cash Price |
$533.50
|
| Rate for Payer: Cash Price |
$533.50
|
| Rate for Payer: Cigna Commercial |
$785.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$757.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$757.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.13
|
| Rate for Payer: Multiplan Commercial |
$992.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$588.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$414.12
|
| Rate for Payer: United Healthcare Commercial |
$637.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$414.12
|
| Rate for Payer: United Healthcare VA CCN |
$414.12
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
5102360501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$845.19 |
| Max. Negotiated Rate |
$1,084.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,084.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$970.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$959.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$913.60
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$913.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$913.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$913.60
|
| Rate for Payer: Multiplan Commercial |
$1,062.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$970.70
|
| Rate for Payer: United Healthcare Commercial |
$1,084.90
|
|
|
CLTX PRX HMRL FX MNPJ+-TRACT
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
9822360501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$789.69 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,013.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$789.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$789.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$906.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$896.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$853.60
|
| Rate for Payer: Cash Price |
$533.50
|
| Rate for Payer: Cigna Commercial |
$853.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$853.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$853.60
|
| Rate for Payer: Multiplan Commercial |
$992.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$906.95
|
| Rate for Payer: United Healthcare Commercial |
$1,013.65
|
|
