|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775001
|
|
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 TIBIAL SHAFT FX W/O MANIP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775001
|
|
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 TIBIAL SHAFT FX W/O MANIP
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$601.75 |
| 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 |
$327.29
|
| 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 |
$444.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$365.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.52
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare Commercial |
$488.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare VA CCN |
$317.76
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9602775002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$601.75 |
| Rate for Payer: Aetna of VT Commercial |
$477.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$444.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$365.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.52
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.45
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare Commercial |
$488.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare VA CCN |
$317.76
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
OP
|
$303.04
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
4502775001
|
|
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 TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.99 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna of VT Commercial |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.20
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.20
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.40
|
| Rate for Payer: United Healthcare Commercial |
$288.80
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9602775002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$375.97 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.40
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$375.97 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.40
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna of VT Commercial |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$241.68
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$243.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$243.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.80
|
| Rate for Payer: United Healthcare Commercial |
$288.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.80
|
| Rate for Payer: United Healthcare VA CCN |
$136.80
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
5102775001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$601.75 |
| Rate for Payer: Aetna of VT Commercial |
$285.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$444.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$365.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.52
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.45
|
| Rate for Payer: Multiplan Commercial |
$282.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare Commercial |
$488.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare VA CCN |
$317.76
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$601.75 |
| Rate for Payer: Aetna of VT Commercial |
$477.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$444.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$365.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.52
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.45
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$451.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare Commercial |
$488.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.76
|
| Rate for Payer: United Healthcare VA CCN |
$317.76
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9812775002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$224.99 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$411.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.86
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.60
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare VA CCN |
$228.60
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$303.04
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
4502775001
|
|
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 TIBIAL SHAFT FX W/O MANIP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9602775002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$224.99 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$224.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$305.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$411.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.86
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.60
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.60
|
| Rate for Payer: United Healthcare VA CCN |
$228.60
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIP
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9602775001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$600.22 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna of VT Commercial |
$770.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$600.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$600.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$681.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$648.80
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$648.80
|
| Rate for Payer: Multiplan Commercial |
$754.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$689.35
|
| Rate for Payer: United Healthcare Commercial |
$770.45
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
IP
|
$5,326.65
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
4502866501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,942.25 |
| Max. Negotiated Rate |
$5,060.32 |
| Rate for Payer: Aetna of VT Commercial |
$5,060.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,942.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,942.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,527.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,474.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,261.32
|
| Rate for Payer: Cash Price |
$2,663.32
|
| Rate for Payer: Cigna Commercial |
$4,261.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,261.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,261.32
|
| Rate for Payer: Multiplan Commercial |
$4,953.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,527.65
|
| Rate for Payer: United Healthcare Commercial |
$5,060.32
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$334.64 |
| Rate for Payer: Aetna of VT Commercial |
$334.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.80
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$230.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.91
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$186.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare VA CCN |
$121.18
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$157.67 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna of VT Commercial |
$338.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.02
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.20
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.20
|
| Rate for Payer: United Healthcare VA CCN |
$160.20
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna of VT Commercial |
$338.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.80
|
| Rate for Payer: Cash Price |
$178.00
|
| Rate for Payer: Cigna Commercial |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.80
|
| Rate for Payer: Multiplan Commercial |
$331.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.60
|
| Rate for Payer: United Healthcare Commercial |
$338.20
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
OP
|
$5,326.65
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
4502866501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,359.17 |
| Max. Negotiated Rate |
$5,060.32 |
| Rate for Payer: Aetna of VT Commercial |
$5,060.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,772.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,359.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,772.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,206.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,527.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,314.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,396.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,234.69
|
| Rate for Payer: Cash Price |
$2,663.32
|
| Rate for Payer: Cigna Commercial |
$4,261.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,261.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,261.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,396.99
|
| Rate for Payer: Multiplan Commercial |
$4,953.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,527.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,396.99
|
| Rate for Payer: United Healthcare Commercial |
$5,060.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,396.99
|
| Rate for Payer: United Healthcare VA CCN |
$2,396.99
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$162.99 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.56
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare VA CCN |
$165.60
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$294.40
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
|
|
CLTX TOE JOINT DISLC REQ ANES
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
9812866502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna of VT Commercial |
$345.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.80
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$230.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.91
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare Commercial |
$186.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.18
|
| Rate for Payer: United Healthcare VA CCN |
$121.18
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
OP
|
$317.08
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
4502866001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$301.23 |
| Rate for Payer: Aetna of VT Commercial |
$301.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.08
|
| Rate for Payer: Cash Price |
$158.54
|
| Rate for Payer: Cigna Commercial |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.69
|
| Rate for Payer: Multiplan Commercial |
$294.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.69
|
| Rate for Payer: United Healthcare Commercial |
$301.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.69
|
| Rate for Payer: United Healthcare VA CCN |
$142.69
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9812866001
|
|
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
|
|
