|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9811204602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$293.71 |
| Max. Negotiated Rate |
$1,338.56 |
| Rate for Payer: Aetna of VT Commercial |
$1,338.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.43
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$536.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$773.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$773.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.84
|
| Rate for Payer: Multiplan Commercial |
$1,324.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare Commercial |
$451.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare VA CCN |
$293.71
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9811204601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.43
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$536.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$773.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$773.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.84
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare Commercial |
$451.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare VA CCN |
$293.71
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9811204601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9821204501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$719.38 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of VT Commercial |
$923.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$719.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$719.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$826.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$816.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.60
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$777.60
|
| Rate for Payer: Multiplan Commercial |
$903.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$826.20
|
| Rate for Payer: United Healthcare Commercial |
$923.40
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9821204601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$293.71 |
| Max. Negotiated Rate |
$1,338.56 |
| Rate for Payer: Aetna of VT Commercial |
$1,338.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$678.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.43
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$536.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$773.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$773.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.84
|
| Rate for Payer: Multiplan Commercial |
$1,324.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare Commercial |
$451.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.71
|
| Rate for Payer: United Healthcare VA CCN |
$293.71
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9821204601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,053.90 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,352.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,053.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,053.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,210.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,196.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,139.20
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,139.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,139.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,139.20
|
| Rate for Payer: Multiplan Commercial |
$1,324.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,210.40
|
| Rate for Payer: United Healthcare Commercial |
$1,352.80
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
9821204601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$630.69 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,352.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$630.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$857.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,210.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,153.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$640.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,132.08
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,139.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,139.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,139.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$640.80
|
| Rate for Payer: Multiplan Commercial |
$1,324.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,210.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$640.80
|
| Rate for Payer: United Healthcare Commercial |
$1,352.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$640.80
|
| Rate for Payer: United Healthcare VA CCN |
$640.80
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9811204502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of VT Commercial |
$923.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$826.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.74
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$777.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$903.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$826.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$923.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.40
|
| Rate for Payer: United Healthcare VA CCN |
$437.40
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$972.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9821204501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$255.06 |
| Max. Negotiated Rate |
$913.68 |
| Rate for Payer: Aetna of VT Commercial |
$913.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$262.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$357.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$293.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.03
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$468.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$388.36
|
| Rate for Payer: Multiplan Commercial |
$903.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$362.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$255.06
|
| Rate for Payer: United Healthcare Commercial |
$392.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.06
|
| Rate for Payer: United Healthcare VA CCN |
$255.06
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$1,008.15
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
4501204501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.51 |
| Max. Negotiated Rate |
$957.74 |
| Rate for Payer: Aetna of VT Commercial |
$957.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$446.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$606.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$856.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$816.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$453.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$801.48
|
| Rate for Payer: Cash Price |
$504.08
|
| Rate for Payer: Cigna Commercial |
$806.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$806.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$806.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.67
|
| Rate for Payer: Multiplan Commercial |
$937.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$856.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$453.67
|
| Rate for Payer: United Healthcare Commercial |
$957.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$453.67
|
| Rate for Payer: United Healthcare VA CCN |
$453.67
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$1,008.15
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
4501204501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$746.13 |
| Max. Negotiated Rate |
$957.74 |
| Rate for Payer: Aetna of VT Commercial |
$957.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$856.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$846.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$806.52
|
| Rate for Payer: Cash Price |
$504.08
|
| Rate for Payer: Cigna Commercial |
$806.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$806.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$806.52
|
| Rate for Payer: Multiplan Commercial |
$937.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$856.93
|
| Rate for Payer: United Healthcare Commercial |
$957.74
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$3,825.80
|
|
|
Service Code
|
CPT 12046
|
| Hospital Charge Code |
4501204601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,831.47 |
| Max. Negotiated Rate |
$3,634.51 |
| Rate for Payer: Aetna of VT Commercial |
$3,634.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,831.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,831.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,251.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,213.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,060.64
|
| Rate for Payer: Cash Price |
$1,912.90
|
| Rate for Payer: Cigna Commercial |
$3,060.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,060.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,060.64
|
| Rate for Payer: Multiplan Commercial |
$3,557.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,251.93
|
| Rate for Payer: United Healthcare Commercial |
$3,634.51
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9811204501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9811204501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$636.71 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$262.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$357.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$293.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.03
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$468.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$388.36
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$362.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$255.06
|
| Rate for Payer: United Healthcare Commercial |
$392.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.06
|
| Rate for Payer: United Healthcare VA CCN |
$255.06
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9811204501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9821204501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of VT Commercial |
$923.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$870.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$826.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.74
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$777.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$903.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$826.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.40
|
| Rate for Payer: United Healthcare Commercial |
$923.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.40
|
| Rate for Payer: United Healthcare VA CCN |
$437.40
|
|
|
INTMD RPR N-HF/GENIT12.6-20
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
9811204502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$719.38 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna of VT Commercial |
$923.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$719.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$719.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$826.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$816.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$777.60
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Cigna Commercial |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$777.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$777.60
|
| Rate for Payer: Multiplan Commercial |
$903.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$826.20
|
| Rate for Payer: United Healthcare Commercial |
$923.40
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9601204102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$410.02 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.20
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9601204101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$1,110.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,110.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,058.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.51
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cash Price |
$590.50
|
| Rate for Payer: Cigna Commercial |
$250.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$404.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$404.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.79
|
| Rate for Payer: Multiplan Commercial |
$1,098.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare VA CCN |
$137.66
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9821204101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$520.76 |
| Rate for Payer: Aetna of VT Commercial |
$520.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.51
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$250.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$404.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$404.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.79
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare VA CCN |
$137.66
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9601204102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$245.37 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$333.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$448.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.43
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.30
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare VA CCN |
$249.30
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9821204101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$410.02 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.20
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
5101204101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$278.14 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Aetna of VT Commercial |
$596.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$533.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$508.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$499.26
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.60
|
| Rate for Payer: Multiplan Commercial |
$584.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$533.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.60
|
| Rate for Payer: United Healthcare Commercial |
$596.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.60
|
| Rate for Payer: United Healthcare VA CCN |
$282.60
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
5101204101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$464.78 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Aetna of VT Commercial |
$596.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$464.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$464.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$533.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$527.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$502.40
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.40
|
| Rate for Payer: Multiplan Commercial |
$584.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$533.80
|
| Rate for Payer: United Healthcare Commercial |
$596.60
|
|
|
INTMD RPR N-HF/GENIT 2.5CM/<
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
5101204101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$590.32 |
| Rate for Payer: Aetna of VT Commercial |
$590.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.51
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$250.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$404.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$404.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.79
|
| Rate for Payer: Multiplan Commercial |
$584.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare VA CCN |
$137.66
|
|
