|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.46 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna of VT Commercial |
$411.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$346.40
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.40
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.05
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.78 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Aetna of VT Commercial |
$411.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$350.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$194.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.24
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.85
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.85
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.85
|
| Rate for Payer: United Healthcare VA CCN |
$194.85
|
|
|
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
9601164002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$407.02 |
| Rate for Payer: Aetna of VT Commercial |
$407.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.82
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna Commercial |
$135.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$313.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$313.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$192.76
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.17
|
| Rate for Payer: United Healthcare Commercial |
$184.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.17
|
| Rate for Payer: United Healthcare VA CCN |
$120.17
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
5101164101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$365.67 |
| Rate for Payer: Aetna of VT Commercial |
$351.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.23
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$224.56
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare Commercial |
$226.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare VA CCN |
$147.15
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
5101164101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.64 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna of VT Commercial |
$355.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$297.33
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$299.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$168.30
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$355.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.30
|
| Rate for Payer: United Healthcare VA CCN |
$168.30
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna of VT Commercial |
$493.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.23
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$224.56
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare Commercial |
$226.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare VA CCN |
$147.15
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9821164101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$365.67 |
| Rate for Payer: Aetna of VT Commercial |
$232.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.23
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$224.56
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare Commercial |
$226.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare VA CCN |
$147.15
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9821164101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$182.80 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna of VT Commercial |
$234.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.60
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.60
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.95
|
| Rate for Payer: United Healthcare Commercial |
$234.65
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
5101164101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$276.80 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna of VT Commercial |
$355.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.20
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$299.20
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.90
|
| Rate for Payer: United Healthcare Commercial |
$355.30
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$844.12 |
| Rate for Payer: Aetna of VT Commercial |
$844.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$804.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$804.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.23
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$224.56
|
| Rate for Payer: Multiplan Commercial |
$835.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare Commercial |
$226.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.15
|
| Rate for Payer: United Healthcare VA CCN |
$147.15
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$397.72 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna of VT Commercial |
$853.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$804.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$397.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$804.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$763.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$727.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$713.91
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$718.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.10
|
| Rate for Payer: Multiplan Commercial |
$835.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$763.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.10
|
| Rate for Payer: United Healthcare Commercial |
$853.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.10
|
| Rate for Payer: United Healthcare VA CCN |
$404.10
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$664.61 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna of VT Commercial |
$853.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$763.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$754.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$718.40
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$718.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$718.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$718.40
|
| Rate for Payer: Multiplan Commercial |
$835.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$763.30
|
| Rate for Payer: United Healthcare Commercial |
$853.10
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$388.55 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna of VT Commercial |
$498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$420.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$446.25
|
| Rate for Payer: United Healthcare Commercial |
$498.75
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9821164101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna of VT Commercial |
$234.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.37
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.15
|
| Rate for Payer: Multiplan Commercial |
$229.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.15
|
| Rate for Payer: United Healthcare Commercial |
$234.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.15
|
| Rate for Payer: United Healthcare VA CCN |
$111.15
|
|
|
EXC F/E/E/N/L MAL+MRG 0.6-1
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
9601164102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$232.52 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna of VT Commercial |
$498.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$316.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$425.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.38
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$446.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$498.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.25
|
| Rate for Payer: United Healthcare VA CCN |
$236.25
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9821164201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.00
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.45
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare VA CCN |
$162.45
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
5101164201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$276.80 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna of VT Commercial |
$355.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.20
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$299.20
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.90
|
| Rate for Payer: United Healthcare Commercial |
$355.30
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9821164201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$171.54 |
| Max. Negotiated Rate |
$414.01 |
| Rate for Payer: Aetna of VT Commercial |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.67
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$192.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$254.09
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare Commercial |
$263.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare VA CCN |
$171.54
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9601164201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$727.52 |
| Max. Negotiated Rate |
$933.85 |
| Rate for Payer: Aetna of VT Commercial |
$933.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$727.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$727.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$835.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$825.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$786.40
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$786.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$786.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$786.40
|
| Rate for Payer: Multiplan Commercial |
$914.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$835.55
|
| Rate for Payer: United Healthcare Commercial |
$933.85
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9821164201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$267.18 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.80
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
5101164201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.64 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna of VT Commercial |
$355.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$297.33
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$299.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$299.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$168.30
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$355.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.30
|
| Rate for Payer: United Healthcare VA CCN |
$168.30
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9601164202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$451.46 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Aetna of VT Commercial |
$579.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$451.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$518.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$512.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$488.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.00
|
| Rate for Payer: Multiplan Commercial |
$567.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$518.50
|
| Rate for Payer: United Healthcare Commercial |
$579.50
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9601164202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.17 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Aetna of VT Commercial |
$579.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$546.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$546.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$518.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$484.95
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$488.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$567.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$518.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.50
|
| Rate for Payer: United Healthcare Commercial |
$579.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.50
|
| Rate for Payer: United Healthcare VA CCN |
$274.50
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9601164202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.54 |
| Max. Negotiated Rate |
$573.40 |
| Rate for Payer: Aetna of VT Commercial |
$573.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$546.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$546.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.67
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$192.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$254.09
|
| Rate for Payer: Multiplan Commercial |
$567.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare Commercial |
$263.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare VA CCN |
$171.54
|
|
|
EXC F/E/E/N/L MAL+MRG 1.1-2
|
Professional
|
Both
|
$983.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
9601164201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.54 |
| Max. Negotiated Rate |
$924.02 |
| Rate for Payer: Aetna of VT Commercial |
$924.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$880.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$880.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.67
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cash Price |
$491.50
|
| Rate for Payer: Cigna Commercial |
$192.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$254.09
|
| Rate for Payer: Multiplan Commercial |
$914.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare Commercial |
$263.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.54
|
| Rate for Payer: United Healthcare VA CCN |
$171.54
|
|
