|
RPR AA HRN 1ST 3-10 NCR/STRN
|
Professional
|
Both
|
$1,607.00
|
|
|
Service Code
|
CPT 49594
|
| Hospital Charge Code |
9824959401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$672.20 |
| Max. Negotiated Rate |
$1,510.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,510.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$692.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$941.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$969.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$969.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$773.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$969.45
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,229.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,154.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,154.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.20
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$954.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.20
|
| Rate for Payer: United Healthcare Commercial |
$1,034.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.20
|
| Rate for Payer: United Healthcare VA CCN |
$672.20
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
9824959301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna of VT Commercial |
$322.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.20
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$271.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$271.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$315.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$288.15
|
| Rate for Payer: United Healthcare Commercial |
$322.05
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
9824959301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$303.71 |
| Max. Negotiated Rate |
$946.02 |
| Rate for Payer: Aetna of VT Commercial |
$318.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$303.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$532.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$303.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$724.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$745.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$745.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$594.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$745.37
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$946.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$887.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$887.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$517.22
|
| Rate for Payer: Multiplan Commercial |
$315.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$734.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$517.21
|
| Rate for Payer: United Healthcare Commercial |
$795.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$517.21
|
| Rate for Payer: United Healthcare VA CCN |
$517.21
|
|
|
RPR AA HRN 1ST 3-10 RDC
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
9824959301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$150.14 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna of VT Commercial |
$322.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$303.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$150.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$303.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$274.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$271.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$271.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$271.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.55
|
| Rate for Payer: Multiplan Commercial |
$315.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$288.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.55
|
| Rate for Payer: United Healthcare Commercial |
$322.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.55
|
| Rate for Payer: United Healthcare VA CCN |
$152.55
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Professional
|
Both
|
$1,607.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
9824959101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$309.92 |
| Max. Negotiated Rate |
$1,510.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,510.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$433.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$445.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$356.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.62
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$566.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$530.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$530.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$309.92
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$309.92
|
| Rate for Payer: United Healthcare Commercial |
$476.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.92
|
| Rate for Payer: United Healthcare VA CCN |
$309.92
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
9824959101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$711.74 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,526.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$711.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$967.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,365.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,301.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$723.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,277.57
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,285.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$723.15
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,365.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$723.15
|
| Rate for Payer: United Healthcare Commercial |
$1,526.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$723.15
|
| Rate for Payer: United Healthcare VA CCN |
$723.15
|
|
|
RPR AA HRN 1ST < 3 CM RDC
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
9824959101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,189.34 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,526.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,189.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,189.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,365.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,349.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.60
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,285.60
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,365.95
|
| Rate for Payer: United Healthcare Commercial |
$1,526.65
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
9824959201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$429.79 |
| Max. Negotiated Rate |
$1,259.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,259.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,200.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$442.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,200.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$601.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$618.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$618.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$494.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$618.63
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$785.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$737.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$737.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$429.79
|
| Rate for Payer: Multiplan Commercial |
$1,246.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$610.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$429.79
|
| Rate for Payer: United Healthcare Commercial |
$661.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$429.79
|
| Rate for Payer: United Healthcare VA CCN |
$429.79
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
9824959201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$593.49 |
| Max. Negotiated Rate |
$1,273.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,200.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$593.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,200.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$806.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,139.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,085.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,065.30
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,072.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,072.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,072.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$603.00
|
| Rate for Payer: Multiplan Commercial |
$1,246.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,139.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$603.00
|
| Rate for Payer: United Healthcare Commercial |
$1,273.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$603.00
|
| Rate for Payer: United Healthcare VA CCN |
$603.00
|
|
|
RPR AA HRN 1ST < 3 NCR/STRN
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
9824959201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$991.73 |
| Max. Negotiated Rate |
$1,273.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,273.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$991.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$991.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,139.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,125.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,072.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,072.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,072.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,072.00
|
| Rate for Payer: Multiplan Commercial |
$1,246.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,139.00
|
| Rate for Payer: United Healthcare Commercial |
$1,273.00
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
9824961401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$515.91 |
| Max. Negotiated Rate |
$943.62 |
| Rate for Payer: Aetna of VT Commercial |
$562.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$531.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$722.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$743.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$743.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$593.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$743.49
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$943.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$515.91
|
| Rate for Payer: Multiplan Commercial |
$556.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$732.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$515.91
|
| Rate for Payer: United Healthcare Commercial |
$793.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$515.91
|
| Rate for Payer: United Healthcare VA CCN |
$515.91
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
9824961401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$442.58 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna of VT Commercial |
$568.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$442.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$442.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$502.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$478.40
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$478.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.40
|
| Rate for Payer: Multiplan Commercial |
$556.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.30
|
| Rate for Payer: United Healthcare Commercial |
$568.10
|
|
|
RPR AA HRN RCR < 3 NCR/STRN
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
9824961401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$264.85 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna of VT Commercial |
$568.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$484.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$269.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.41
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$478.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$556.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$269.10
|
| Rate for Payer: United Healthcare Commercial |
$568.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$269.10
|
| Rate for Payer: United Healthcare VA CCN |
$269.10
|
|
|
RPR EPIGASTRIC HERN BLOCKED
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
CPT 49572
|
| Hospital Charge Code |
9824957201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$1,499.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,499.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,428.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,428.96
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Multiplan Commercial |
$1,483.35
|
| Rate for Payer: United Healthcare Commercial |
$1,355.75
|
| Rate for Payer: United Healthcare VA CCN |
$638.00
|
|
|
RPR EPIGASTRIC HERN BLOCKED
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 49572
|
| Hospital Charge Code |
9824957201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,180.46 |
| Max. Negotiated Rate |
$1,515.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,515.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,180.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,180.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,355.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,339.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,276.00
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Cigna Commercial |
$1,276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,276.00
|
| Rate for Payer: Multiplan Commercial |
$1,483.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,355.75
|
| Rate for Payer: United Healthcare Commercial |
$1,515.25
|
|
|
RPR EPIGASTRIC HERN BLOCKED
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 49572
|
| Hospital Charge Code |
9824957201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$706.43 |
| Max. Negotiated Rate |
$1,515.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,515.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,428.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$706.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,428.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$960.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,355.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,291.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$717.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,268.03
|
| Rate for Payer: Cash Price |
$797.50
|
| Rate for Payer: Cigna Commercial |
$1,276.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,276.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,276.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$717.75
|
| Rate for Payer: Multiplan Commercial |
$1,483.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,355.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$717.75
|
| Rate for Payer: United Healthcare Commercial |
$1,515.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$717.75
|
| Rate for Payer: United Healthcare VA CCN |
$717.75
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$543.23 |
| Max. Negotiated Rate |
$697.30 |
| Rate for Payer: Aetna of VT Commercial |
$697.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$543.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$543.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$623.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$616.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$587.20
|
| Rate for Payer: Cash Price |
$367.00
|
| Rate for Payer: Cigna Commercial |
$587.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$587.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$587.20
|
| Rate for Payer: Multiplan Commercial |
$682.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$623.90
|
| Rate for Payer: United Healthcare Commercial |
$697.30
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$464.77 |
| 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 |
$117.97
|
| 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 |
$160.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.77
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$211.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$205.11
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.53
|
| Rate for Payer: United Healthcare Commercial |
$176.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.53
|
| Rate for Payer: United Healthcare VA CCN |
$114.53
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$689.96 |
| Rate for Payer: Aetna of VT Commercial |
$689.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$657.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$657.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.77
|
| Rate for Payer: Cash Price |
$367.00
|
| Rate for Payer: Cash Price |
$367.00
|
| Rate for Payer: Cigna Commercial |
$211.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$205.11
|
| Rate for Payer: Multiplan Commercial |
$682.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.53
|
| Rate for Payer: United Healthcare Commercial |
$176.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.53
|
| Rate for Payer: United Healthcare VA CCN |
$114.53
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$325.09 |
| Max. Negotiated Rate |
$697.30 |
| Rate for Payer: Aetna of VT Commercial |
$697.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$657.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$325.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$657.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$441.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$623.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$594.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.53
|
| Rate for Payer: Cash Price |
$367.00
|
| Rate for Payer: Cigna Commercial |
$587.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$587.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$587.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$330.30
|
| Rate for Payer: Multiplan Commercial |
$682.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$623.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$330.30
|
| Rate for Payer: United Healthcare Commercial |
$697.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$330.30
|
| Rate for Payer: United Healthcare VA CCN |
$330.30
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
IP
|
$723.80
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
4501201601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$535.68 |
| Max. Negotiated Rate |
$687.61 |
| Rate for Payer: Aetna of VT Commercial |
$687.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$607.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.04
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cigna Commercial |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.04
|
| Rate for Payer: Multiplan Commercial |
$673.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.23
|
| Rate for Payer: United Healthcare Commercial |
$687.61
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
OP
|
$723.80
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
4501201601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$687.61 |
| Rate for Payer: Aetna of VT Commercial |
$687.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$320.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$435.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$586.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$575.42
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cigna Commercial |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.71
|
| Rate for Payer: Multiplan Commercial |
$673.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.71
|
| Rate for Payer: United Healthcare Commercial |
$687.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.71
|
| Rate for Payer: United Healthcare VA CCN |
$325.71
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201601
|
|
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
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
9811201601
|
|
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
|
|
|
RPR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
9811201702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$138.17 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna of VT Commercial |
$744.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$709.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$709.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$354.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.70
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$253.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.17
|
| Rate for Payer: Multiplan Commercial |
$736.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.18
|
| Rate for Payer: United Healthcare Commercial |
$212.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.18
|
| Rate for Payer: United Healthcare VA CCN |
$138.18
|
|
