|
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
|
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
|
IP
|
$811.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
9601160101
|
|
Hospital Revenue Code
|
960
|
| 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
|
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 1.1-2 CM
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$255.11 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of VT Commercial |
$547.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$516.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$255.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$516.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$346.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$457.92
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$460.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$535.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$259.20
|
| Rate for Payer: United Healthcare Commercial |
$547.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.20
|
| Rate for Payer: United Healthcare VA CCN |
$259.20
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna of VT Commercial |
$541.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$516.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$516.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.55
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$171.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$535.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare VA CCN |
$153.10
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
5101160201
|
|
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 MAL+MARG 1.1-2 CM
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna of VT Commercial |
$547.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.80
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$460.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.80
|
| Rate for Payer: Multiplan Commercial |
$535.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.60
|
| Rate for Payer: United Healthcare Commercial |
$547.20
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
5101160201
|
|
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 1.1-2 CM
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$703.10 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Aetna of VT Commercial |
$902.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$703.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$703.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$807.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$798.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$760.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$760.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.00
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$807.50
|
| Rate for Payer: United Healthcare Commercial |
$902.50
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9821160201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.00
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.45
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare VA CCN |
$162.45
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9821160201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$378.01 |
| Rate for Payer: Aetna of VT Commercial |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.55
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$171.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare VA CCN |
$153.10
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
5101160201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$378.01 |
| 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 |
$157.69
|
| 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 |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.55
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$171.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$347.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare VA CCN |
$153.10
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9821160201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$267.18 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.80
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna of VT Commercial |
$893.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$851.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$851.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.55
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$171.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.10
|
| Rate for Payer: United Healthcare VA CCN |
$153.10
|
|
|
EXC TR-EXT MAL+MARG 1.1-2 CM
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
9601160201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.75 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Aetna of VT Commercial |
$902.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$851.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$851.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$571.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$807.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$769.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$427.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.25
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$760.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$427.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$807.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$427.50
|
| Rate for Payer: United Healthcare Commercial |
$902.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.50
|
| Rate for Payer: United Healthcare VA CCN |
$427.50
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9601160301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$658.15 |
| Max. Negotiated Rate |
$1,411.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,411.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,331.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$658.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,331.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,263.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,203.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$668.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,181.37
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$1,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$668.70
|
| Rate for Payer: Multiplan Commercial |
$1,381.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,263.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$668.70
|
| Rate for Payer: United Healthcare Commercial |
$1,411.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.70
|
| Rate for Payer: United Healthcare VA CCN |
$668.70
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9601160301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,099.79 |
| Max. Negotiated Rate |
$1,411.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,411.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,099.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,099.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,263.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,248.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.80
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$1,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,188.80
|
| Rate for Payer: Multiplan Commercial |
$1,381.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,263.10
|
| Rate for Payer: United Healthcare Commercial |
$1,411.70
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9601160302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$620.94 |
| Max. Negotiated Rate |
$797.05 |
| Rate for Payer: Aetna of VT Commercial |
$797.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$704.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$671.20
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$671.20
|
| Rate for Payer: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$713.15
|
| Rate for Payer: United Healthcare Commercial |
$797.05
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9601160302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$371.59 |
| Max. Negotiated Rate |
$797.05 |
| Rate for Payer: Aetna of VT Commercial |
$797.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$751.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$751.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$505.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$667.00
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$671.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$377.55
|
| Rate for Payer: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$713.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$377.55
|
| Rate for Payer: United Healthcare Commercial |
$797.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.55
|
| Rate for Payer: United Healthcare VA CCN |
$377.55
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Professional
|
Both
|
$1,486.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9601160301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.35 |
| Max. Negotiated Rate |
$1,396.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,396.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,331.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,331.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.80
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cash Price |
$743.00
|
| Rate for Payer: Cigna Commercial |
$204.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$264.58
|
| Rate for Payer: Multiplan Commercial |
$1,381.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.35
|
| Rate for Payer: United Healthcare Commercial |
$280.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.35
|
| Rate for Payer: United Healthcare VA CCN |
$182.35
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
5101160301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$479.58 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of VT Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$479.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$479.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$544.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$518.40
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.40
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.80
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
9821160301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$341.48 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Aetna of VT Commercial |
$732.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$690.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$690.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$464.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$655.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$346.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.95
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$616.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$616.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$616.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.95
|
| Rate for Payer: Multiplan Commercial |
$717.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$655.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.95
|
| Rate for Payer: United Healthcare Commercial |
$732.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.95
|
| Rate for Payer: United Healthcare VA CCN |
$346.95
|
|
|
EXC TR-EXT MAL+MARG 2.1-3 CM
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
5101160301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of VT Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$550.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$524.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.16
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.60
|
| Rate for Payer: Multiplan Commercial |
$602.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$550.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.60
|
| Rate for Payer: United Healthcare VA CCN |
$291.60
|
|
