|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9821142201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Professional
|
Both
|
$2,279.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$2,142.26 |
| Rate for Payer: Aetna of VT Commercial |
$2,142.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,041.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,041.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$173.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.14
|
| Rate for Payer: Cash Price |
$1,139.50
|
| Rate for Payer: Cash Price |
$1,139.50
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.63
|
| Rate for Payer: Multiplan Commercial |
$2,119.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare Commercial |
$231.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare VA CCN |
$150.66
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,686.69 |
| Max. Negotiated Rate |
$2,165.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,165.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,686.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,686.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,937.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,914.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,139.50
|
| Rate for Payer: Cigna Commercial |
$1,823.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,823.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,823.20
|
| Rate for Payer: Multiplan Commercial |
$2,119.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,937.15
|
| Rate for Payer: United Healthcare Commercial |
$2,165.05
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,009.37 |
| Max. Negotiated Rate |
$2,165.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,165.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,041.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,009.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,041.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,371.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,937.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,845.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,025.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,811.81
|
| Rate for Payer: Cash Price |
$1,139.50
|
| Rate for Payer: Cigna Commercial |
$1,823.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,823.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,823.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,025.55
|
| Rate for Payer: Multiplan Commercial |
$2,119.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,937.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,025.55
|
| Rate for Payer: United Healthcare Commercial |
$2,165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,025.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,025.55
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$218.35 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna of VT Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.94
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.85
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare VA CCN |
$221.85
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
5101142301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$791.46 |
| Max. Negotiated Rate |
$1,697.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,697.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,600.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$791.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,600.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,075.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,518.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,447.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$804.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,420.66
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$1,429.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,429.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,429.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$804.15
|
| Rate for Payer: Multiplan Commercial |
$1,661.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,518.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$804.15
|
| Rate for Payer: United Healthcare Commercial |
$1,697.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$804.15
|
| Rate for Payer: United Healthcare VA CCN |
$804.15
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
5101142301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,322.56 |
| Max. Negotiated Rate |
$1,697.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,697.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,322.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,322.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,518.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,501.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,429.60
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$1,429.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,429.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,429.60
|
| Rate for Payer: Multiplan Commercial |
$1,661.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,518.95
|
| Rate for Payer: United Healthcare Commercial |
$1,697.65
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9821142301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna of VT Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.40
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.40
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9821142301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$463.42 |
| Rate for Payer: Aetna of VT Commercial |
$463.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$173.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.14
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.63
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare Commercial |
$231.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare VA CCN |
$150.66
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna of VT Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.40
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.40
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
5101142301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,679.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,679.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,600.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,600.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$173.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.14
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.63
|
| Rate for Payer: Multiplan Commercial |
$1,661.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare Commercial |
$231.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare VA CCN |
$150.66
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9821142301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$218.35 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna of VT Commercial |
$468.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.94
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.85
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$468.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.85
|
| Rate for Payer: United Healthcare VA CCN |
$221.85
|
|
|
EXC H-F-NK-SP B9+MARG 2.1-3
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
9601142302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$463.42 |
| Rate for Payer: Aetna of VT Commercial |
$463.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$173.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.14
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$168.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.63
|
| Rate for Payer: Multiplan Commercial |
$458.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare Commercial |
$231.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: United Healthcare VA CCN |
$150.66
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$800.05 |
| Max. Negotiated Rate |
$1,026.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,026.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$918.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$908.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$864.80
|
| Rate for Payer: Cash Price |
$540.50
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$864.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$864.80
|
| Rate for Payer: Multiplan Commercial |
$1,005.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.85
|
| Rate for Payer: United Healthcare Commercial |
$1,026.95
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9821142401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$370.30 |
| Rate for Payer: Aetna of VT Commercial |
$224.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$241.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.21
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$192.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.83
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare Commercial |
$264.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare VA CCN |
$172.19
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9821142401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.20
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
5101142401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.76 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Aetna of VT Commercial |
$527.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: United Healthcare Commercial |
$527.25
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
5101142401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$521.70 |
| Rate for Payer: Aetna of VT Commercial |
$521.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$241.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.21
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$192.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.83
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare Commercial |
$264.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare VA CCN |
$172.19
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.41 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Aetna of VT Commercial |
$500.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$472.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$472.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$237.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.96
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$421.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$421.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$421.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$237.15
|
| Rate for Payer: Multiplan Commercial |
$490.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$237.15
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.15
|
| Rate for Payer: United Healthcare VA CCN |
$237.15
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
5101142401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$245.81 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Aetna of VT Commercial |
$527.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$334.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$449.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$249.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$441.23
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$527.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.75
|
| Rate for Payer: United Healthcare VA CCN |
$249.75
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9821142401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$105.85 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.00
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.55
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.55
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.55
|
| Rate for Payer: United Healthcare VA CCN |
$107.55
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$1,016.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,016.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$968.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$968.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$241.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.21
|
| Rate for Payer: Cash Price |
$540.50
|
| Rate for Payer: Cash Price |
$540.50
|
| Rate for Payer: Cigna Commercial |
$192.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.83
|
| Rate for Payer: Multiplan Commercial |
$1,005.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare Commercial |
$264.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare VA CCN |
$172.19
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$390.03 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Aetna of VT Commercial |
$500.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$390.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$390.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$442.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$421.60
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$421.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$421.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$421.60
|
| Rate for Payer: Multiplan Commercial |
$490.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.95
|
| Rate for Payer: United Healthcare Commercial |
$500.65
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$495.38 |
| Rate for Payer: Aetna of VT Commercial |
$495.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$472.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$472.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$241.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.21
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$192.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.83
|
| Rate for Payer: Multiplan Commercial |
$490.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare Commercial |
$264.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.19
|
| Rate for Payer: United Healthcare VA CCN |
$172.19
|
|
|
EXC H-F-NK-SP B9+MARG 3.1-4
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
9601142401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$478.77 |
| Max. Negotiated Rate |
$1,026.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,026.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$968.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$478.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$968.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$650.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$918.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$875.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$486.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$859.39
|
| Rate for Payer: Cash Price |
$540.50
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$864.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$864.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$486.45
|
| Rate for Payer: Multiplan Commercial |
$1,005.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$486.45
|
| Rate for Payer: United Healthcare Commercial |
$1,026.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$486.45
|
| Rate for Payer: United Healthcare VA CCN |
$486.45
|
|
