|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
5101140101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$351.56 |
| 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 |
$103.97
|
| 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 |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$202.89
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$113.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.83
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare Commercial |
$155.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare VA CCN |
$100.94
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$297.52 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna of VT Commercial |
$381.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$297.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$297.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$321.60
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$321.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$321.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$373.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$341.70
|
| Rate for Payer: United Healthcare Commercial |
$381.90
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$377.88 |
| Rate for Payer: Aetna of VT Commercial |
$377.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$202.89
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$113.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.83
|
| Rate for Payer: Multiplan Commercial |
$373.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare Commercial |
$155.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare VA CCN |
$100.94
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
5101140101
|
|
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 TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.58 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Aetna of VT Commercial |
$736.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$573.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$573.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$658.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$651.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$620.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$620.00
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$736.25
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$728.50 |
| Rate for Payer: Aetna of VT Commercial |
$728.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$694.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$202.89
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$113.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.83
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare Commercial |
$155.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.94
|
| Rate for Payer: United Healthcare VA CCN |
$100.94
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Aetna of VT Commercial |
$736.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$343.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$694.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$466.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$658.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$616.12
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$620.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.75
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$658.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$348.75
|
| Rate for Payer: United Healthcare Commercial |
$736.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.75
|
| Rate for Payer: United Healthcare VA CCN |
$348.75
|
|
|
EXC TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
5101140101
|
|
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 TR-EXT B9+MARG 0.6-1 CM
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
9601140102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$178.05 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna of VT Commercial |
$381.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$242.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.59
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$321.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$321.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$321.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$180.90
|
| Rate for Payer: Multiplan Commercial |
$373.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$341.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.90
|
| Rate for Payer: United Healthcare Commercial |
$381.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.90
|
| Rate for Payer: United Healthcare VA CCN |
$180.90
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
5101140201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$351.56 |
| 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 |
$113.61
|
| 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 |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9811140202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.90
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare VA CCN |
$189.00
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
5101140201
|
|
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 TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9601140201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$587.64 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Aetna of VT Commercial |
$754.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$587.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$587.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$674.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$666.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$635.20
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$635.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$635.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$635.20
|
| Rate for Payer: Multiplan Commercial |
$738.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$674.90
|
| Rate for Payer: United Healthcare Commercial |
$754.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9811140202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.84 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9601140201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$746.36 |
| Rate for Payer: Aetna of VT Commercial |
$746.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$711.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$711.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$738.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$373.27
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
4501140201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.26 |
| Max. Negotiated Rate |
$354.61 |
| Rate for Payer: Aetna of VT Commercial |
$354.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.62
|
| Rate for Payer: Cash Price |
$186.64
|
| Rate for Payer: Cigna Commercial |
$298.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.62
|
| Rate for Payer: Multiplan Commercial |
$347.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$317.28
|
| Rate for Payer: United Healthcare Commercial |
$354.61
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
5101140201
|
|
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 TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9811140202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna of VT Commercial |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9601140201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$351.66 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Aetna of VT Commercial |
$754.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$711.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$351.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$711.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$477.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$674.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$643.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$357.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$631.23
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$635.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$635.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$635.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$357.30
|
| Rate for Payer: Multiplan Commercial |
$738.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$674.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$357.30
|
| Rate for Payer: United Healthcare Commercial |
$754.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$357.30
|
| Rate for Payer: United Healthcare VA CCN |
$357.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9601140202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.90
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare VA CCN |
$189.00
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9811140201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna of VT Commercial |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9811140201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.84 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9821140201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna of VT Commercial |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9601140202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.30 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna of VT Commercial |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$123.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.30
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare Commercial |
$169.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.30
|
| Rate for Payer: United Healthcare VA CCN |
$110.30
|
|
|
EXC TR-EXT B9+MARG 1.1-2 CM
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
9821140201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.90
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare VA CCN |
$189.00
|
|
