|
EXC FACE-MM B9+MARG 0.5 CM/<
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
9821144001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$342.16 |
| Rate for Payer: Aetna of VT Commercial |
$342.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$116.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.55
|
| Rate for Payer: Multiplan Commercial |
$338.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.11
|
| Rate for Payer: United Healthcare Commercial |
$158.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.11
|
| Rate for Payer: United Healthcare VA CCN |
$103.11
|
|
|
EXC FACE-MM B9+MARG 0.5 CM/<
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
5101144001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Aetna of VT Commercial |
$489.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$381.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$381.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$432.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.00
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$412.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.00
|
| Rate for Payer: Multiplan Commercial |
$478.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$437.75
|
| Rate for Payer: United Healthcare Commercial |
$489.25
|
|
|
EXC FACE-MM B9+MARG 0.5 CM/<
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
9601144002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.22 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna of VT Commercial |
$345.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$161.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$309.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.38
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$291.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$291.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$338.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$309.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$163.80
|
| Rate for Payer: United Healthcare Commercial |
$345.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.80
|
| Rate for Payer: United Healthcare VA CCN |
$163.80
|
|
|
EXC FACE-MM B9+MARG 0.5 CM/<
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
5101144001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.09 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Aetna of VT Commercial |
$489.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$461.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$461.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$310.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$231.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$409.43
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$412.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$478.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$437.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.75
|
| Rate for Payer: United Healthcare Commercial |
$489.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.75
|
| Rate for Payer: United Healthcare VA CCN |
$231.75
|
|
|
EXC FACE-MM B9+MARG 0.5 CM/<
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
5101144001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.11 |
| Max. Negotiated Rate |
$484.10 |
| Rate for Payer: Aetna of VT Commercial |
$484.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$461.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$461.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.46
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$116.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.55
|
| Rate for Payer: Multiplan Commercial |
$478.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.11
|
| Rate for Payer: United Healthcare Commercial |
$158.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.11
|
| Rate for Payer: United Healthcare VA CCN |
$103.11
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9821144101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$287.16 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.40
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9821144101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna of VT Commercial |
$364.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.48
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$143.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna of VT Commercial |
$364.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.48
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$143.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$233.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.60
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare VA CCN |
$174.60
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$287.16 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.40
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$712.52 |
| Rate for Payer: Aetna of VT Commercial |
$712.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$679.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$679.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.48
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$143.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$704.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
5101144101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna of VT Commercial |
$352.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$315.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$294.94
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.95
|
| Rate for Payer: Multiplan Commercial |
$345.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.95
|
| Rate for Payer: United Healthcare Commercial |
$352.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.95
|
| Rate for Payer: United Healthcare VA CCN |
$166.95
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$335.72 |
| Max. Negotiated Rate |
$720.10 |
| Rate for Payer: Aetna of VT Commercial |
$720.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$679.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$335.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$679.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$456.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$644.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$613.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$602.61
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$606.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$606.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$606.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$341.10
|
| Rate for Payer: Multiplan Commercial |
$704.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$644.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$341.10
|
| Rate for Payer: United Healthcare Commercial |
$720.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.10
|
| Rate for Payer: United Healthcare VA CCN |
$341.10
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9601144101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$720.10 |
| Rate for Payer: Aetna of VT Commercial |
$720.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$561.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$644.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$636.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.40
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$606.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$606.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$606.40
|
| Rate for Payer: Multiplan Commercial |
$704.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$644.30
|
| Rate for Payer: United Healthcare Commercial |
$720.10
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
9821144101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$233.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.60
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare VA CCN |
$174.60
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
5101144101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.35 |
| Max. Negotiated Rate |
$348.74 |
| Rate for Payer: Aetna of VT Commercial |
$348.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.48
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$143.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$345.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.35
|
| Rate for Payer: United Healthcare VA CCN |
$127.35
|
|
|
EXC FACE-MM B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
5101144101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$274.58 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna of VT Commercial |
$352.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$315.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.80
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$345.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.35
|
| Rate for Payer: United Healthcare Commercial |
$352.45
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9821144201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.20
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9601144202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Aetna of VT Commercial |
$502.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$449.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$423.20
|
| Rate for Payer: Cash Price |
$264.50
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$423.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$491.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$449.65
|
| Rate for Payer: United Healthcare Commercial |
$502.55
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
5101144201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$896.76 |
| Rate for Payer: Aetna of VT Commercial |
$896.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$854.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$854.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.43
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$157.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.48
|
| Rate for Payer: Multiplan Commercial |
$887.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
5101144201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$706.06 |
| Max. Negotiated Rate |
$906.30 |
| Rate for Payer: Aetna of VT Commercial |
$906.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$801.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$763.20
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$763.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$763.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$763.20
|
| Rate for Payer: Multiplan Commercial |
$887.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.90
|
| Rate for Payer: United Healthcare Commercial |
$906.30
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9821144201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.23
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.30
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.30
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.30
|
| Rate for Payer: United Healthcare VA CCN |
$87.30
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9821144201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna of VT Commercial |
$182.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.43
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$157.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.48
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9601144201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$656.38 |
| Max. Negotiated Rate |
$1,407.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,407.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$656.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,327.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$892.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,259.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,200.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$666.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,178.19
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,185.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,185.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$1,378.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,259.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$666.90
|
| Rate for Payer: United Healthcare Commercial |
$1,407.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$666.90
|
| Rate for Payer: United Healthcare VA CCN |
$666.90
|
|
|
EXC FACE-MM B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
9601144202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$234.29 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Aetna of VT Commercial |
$502.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$473.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$449.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$428.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$420.56
|
| Rate for Payer: Cash Price |
$264.50
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$423.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$423.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.05
|
| Rate for Payer: Multiplan Commercial |
$491.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$449.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.05
|
| Rate for Payer: United Healthcare Commercial |
$502.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.05
|
| Rate for Payer: United Healthcare VA CCN |
$238.05
|
|
