|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$349.45 |
| Max. Negotiated Rate |
$749.55 |
| Rate for Payer: Aetna of VT Commercial |
$749.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$474.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$670.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$639.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$355.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$627.25
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$631.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$631.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$631.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$355.05
|
| Rate for Payer: Multiplan Commercial |
$733.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$670.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$355.05
|
| Rate for Payer: United Healthcare Commercial |
$749.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.05
|
| Rate for Payer: United Healthcare VA CCN |
$355.05
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$583.94 |
| Max. Negotiated Rate |
$749.55 |
| Rate for Payer: Aetna of VT Commercial |
$749.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$583.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$583.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$670.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$662.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$631.20
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$631.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$631.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$631.20
|
| Rate for Payer: Multiplan Commercial |
$733.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$670.65
|
| Rate for Payer: United Healthcare Commercial |
$749.55
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Professional
|
Both
|
$2,246.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$2,111.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,111.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,012.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,012.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.05
|
| Rate for Payer: Cash Price |
$1,123.00
|
| Rate for Payer: Cash Price |
$1,123.00
|
| Rate for Payer: Cigna Commercial |
$261.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$495.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$495.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.60
|
| Rate for Payer: Multiplan Commercial |
$2,088.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$359.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare VA CCN |
$233.47
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$994.75 |
| Max. Negotiated Rate |
$2,133.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,133.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,012.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$994.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,012.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,909.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,819.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,010.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,123.00
|
| Rate for Payer: Cigna Commercial |
$1,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,796.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,010.70
|
| Rate for Payer: Multiplan Commercial |
$2,088.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,909.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,010.70
|
| Rate for Payer: United Healthcare Commercial |
$2,133.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,010.70
|
| Rate for Payer: United Healthcare VA CCN |
$1,010.70
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$741.66 |
| Rate for Payer: Aetna of VT Commercial |
$741.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$706.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.05
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$261.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$495.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$495.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.60
|
| Rate for Payer: Multiplan Commercial |
$733.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$359.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare VA CCN |
$233.47
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
5101140601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.47 |
| Max. Negotiated Rate |
$1,369.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,369.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,305.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,305.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.05
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cigna Commercial |
$261.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$495.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$495.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.60
|
| Rate for Payer: Multiplan Commercial |
$1,355.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare Commercial |
$359.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.47
|
| Rate for Payer: United Healthcare VA CCN |
$233.47
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
OP
|
$1,457.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
5101140601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$645.31 |
| Max. Negotiated Rate |
$1,384.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,384.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,305.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$645.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,305.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$877.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,238.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,180.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$655.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,158.32
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cigna Commercial |
$1,165.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,165.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,165.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$655.65
|
| Rate for Payer: Multiplan Commercial |
$1,355.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,238.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$655.65
|
| Rate for Payer: United Healthcare Commercial |
$1,384.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$655.65
|
| Rate for Payer: United Healthcare VA CCN |
$655.65
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
IP
|
$1,457.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
5101140601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,078.33 |
| Max. Negotiated Rate |
$1,384.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,384.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,078.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,078.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,238.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,223.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,165.60
|
| Rate for Payer: Cash Price |
$728.50
|
| Rate for Payer: Cigna Commercial |
$1,165.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,165.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,165.60
|
| Rate for Payer: Multiplan Commercial |
$1,355.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,238.45
|
| Rate for Payer: United Healthcare Commercial |
$1,384.15
|
|
|
EXC TR-EXT B9+MARG >4.0 CM
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
9601140601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,662.26 |
| Max. Negotiated Rate |
$2,133.70 |
| Rate for Payer: Aetna of VT Commercial |
$2,133.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,662.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,662.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,909.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,886.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,796.80
|
| Rate for Payer: Cash Price |
$1,123.00
|
| Rate for Payer: Cigna Commercial |
$1,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,796.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,796.80
|
| Rate for Payer: Multiplan Commercial |
$2,088.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,909.10
|
| Rate for Payer: United Healthcare Commercial |
$2,133.70
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.19
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.45
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare VA CCN |
$234.45
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
5101160001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna of VT Commercial |
$803.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.73
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$303.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$303.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.97
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare Commercial |
$177.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare VA CCN |
$115.67
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
5101160001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$632.79 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna of VT Commercial |
$812.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$684.00
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$726.75
|
| Rate for Payer: United Healthcare Commercial |
$812.25
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
5101160001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.68 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Aetna of VT Commercial |
$812.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$378.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$765.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$514.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$384.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.73
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$684.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$684.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$795.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$726.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$812.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.75
|
| Rate for Payer: United Healthcare VA CCN |
$384.75
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$608.99 |
| Max. Negotiated Rate |
$1,306.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,231.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$608.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,231.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$827.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,168.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,113.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$618.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,093.12
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$618.75
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,168.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$618.75
|
| Rate for Payer: United Healthcare Commercial |
$1,306.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$618.75
|
| Rate for Payer: United Healthcare VA CCN |
$618.75
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$1,292.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,292.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,231.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,231.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.73
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$303.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$303.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.97
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare Commercial |
$177.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare VA CCN |
$115.67
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,017.64 |
| Max. Negotiated Rate |
$1,306.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,017.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,017.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,168.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,155.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,100.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,100.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,306.25
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.80
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
|
|
EXC TR-EXT MAL+MARG 0.5 CM/<
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
9601160002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$489.74 |
| Rate for Payer: Aetna of VT Commercial |
$489.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.73
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$303.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$303.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.97
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare Commercial |
$177.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.67
|
| Rate for Payer: United Healthcare VA CCN |
$115.67
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9601160102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.40
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
5101160101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$352.30 |
| 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 |
$144.75
|
| 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 |
$196.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.89
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$157.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.65
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.53
|
| Rate for Payer: United Healthcare Commercial |
$216.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.53
|
| Rate for Payer: United Healthcare VA CCN |
$140.53
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9601160102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9821160101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$359.19 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna of VT Commercial |
$770.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$726.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$359.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$726.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$488.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$656.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$364.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$644.75
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$648.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$364.95
|
| Rate for Payer: Multiplan Commercial |
$754.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$689.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$364.95
|
| Rate for Payer: United Healthcare Commercial |
$770.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$364.95
|
| Rate for Payer: United Healthcare VA CCN |
$364.95
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
5101160101
|
|
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 MAL+MARG 0.6-1 CM
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9821160101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$600.22 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna of VT Commercial |
$770.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$600.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$600.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$689.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$681.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$648.80
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$648.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$648.80
|
| Rate for Payer: Multiplan Commercial |
$754.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$689.35
|
| Rate for Payer: United Healthcare Commercial |
$770.45
|
|
|
EXC TR-EXT MAL+MARG 0.6-1 CM
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9601160101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.53 |
| Max. Negotiated Rate |
$762.34 |
| Rate for Payer: Aetna of VT Commercial |
$762.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$726.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$726.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.89
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$157.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.65
|
| Rate for Payer: Multiplan Commercial |
$754.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.53
|
| Rate for Payer: United Healthcare Commercial |
$216.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.53
|
| Rate for Payer: United Healthcare VA CCN |
$140.53
|
|
