|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
9811201302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.06
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare VA CCN |
$120.60
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$434.69
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
4501201301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.71 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna of VT Commercial |
$412.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.75
|
| Rate for Payer: Cash Price |
$217.34
|
| Rate for Payer: Cigna Commercial |
$347.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.75
|
| Rate for Payer: Multiplan Commercial |
$404.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.49
|
| Rate for Payer: United Healthcare Commercial |
$412.96
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
9811201301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.06
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare VA CCN |
$120.60
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
OP
|
$434.69
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
4501201301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.52 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna of VT Commercial |
$412.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.58
|
| Rate for Payer: Cash Price |
$217.34
|
| Rate for Payer: Cigna Commercial |
$347.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.61
|
| Rate for Payer: Multiplan Commercial |
$404.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.61
|
| Rate for Payer: United Healthcare Commercial |
$412.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.61
|
| Rate for Payer: United Healthcare VA CCN |
$195.61
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
9811201302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$264.30 |
| Rate for Payer: Aetna of VT Commercial |
$251.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.30
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$96.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.33
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.16
|
| Rate for Payer: United Healthcare Commercial |
$80.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.16
|
| Rate for Payer: United Healthcare VA CCN |
$52.16
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
9811201301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
RPR F/E/E/N/L/M 2.6CM-5.0 CM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
9811201302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna of VT Commercial |
$428.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.55
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.95
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.95
|
| Rate for Payer: United Healthcare Commercial |
$428.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.95
|
| Rate for Payer: United Healthcare VA CCN |
$202.95
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$515.97
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
4501201401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.87 |
| Max. Negotiated Rate |
$490.17 |
| Rate for Payer: Aetna of VT Commercial |
$490.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$381.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$381.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.78
|
| Rate for Payer: Cash Price |
$257.98
|
| Rate for Payer: Cigna Commercial |
$412.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.78
|
| Rate for Payer: Multiplan Commercial |
$479.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.57
|
| Rate for Payer: United Healthcare Commercial |
$490.17
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna of VT Commercial |
$428.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.55
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.95
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.95
|
| Rate for Payer: United Healthcare Commercial |
$428.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.95
|
| Rate for Payer: United Healthcare VA CCN |
$202.95
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
OP
|
$515.97
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
4501201401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.52 |
| Max. Negotiated Rate |
$490.17 |
| Rate for Payer: Aetna of VT Commercial |
$490.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$310.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.20
|
| Rate for Payer: Cash Price |
$257.98
|
| Rate for Payer: Cigna Commercial |
$412.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.19
|
| Rate for Payer: Multiplan Commercial |
$479.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$232.19
|
| Rate for Payer: United Healthcare Commercial |
$490.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.19
|
| Rate for Payer: United Healthcare VA CCN |
$232.19
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna of VT Commercial |
$428.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$333.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$333.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$378.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$360.80
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.80
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.35
|
| Rate for Payer: United Healthcare Commercial |
$428.45
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$423.94 |
| Rate for Payer: Aetna of VT Commercial |
$423.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.90
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.58
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare VA CCN |
$67.05
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$423.94 |
| Rate for Payer: Aetna of VT Commercial |
$423.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$311.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.90
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$124.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$219.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$219.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.58
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare Commercial |
$103.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.05
|
| Rate for Payer: United Healthcare VA CCN |
$67.05
|
|
|
RPR F/E/E/N/L/M 5.1CM-7.5 CM
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
9811201401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna of VT Commercial |
$428.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$333.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$333.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$378.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$360.80
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.80
|
| Rate for Payer: Multiplan Commercial |
$419.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.35
|
| Rate for Payer: United Healthcare Commercial |
$428.45
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
IP
|
$351.04
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
4501201501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.80 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna of VT Commercial |
$333.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$259.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$259.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.83
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cigna Commercial |
$280.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.83
|
| Rate for Payer: Multiplan Commercial |
$326.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.38
|
| Rate for Payer: United Healthcare Commercial |
$333.49
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$392.39 |
| Rate for Payer: Aetna of VT Commercial |
$337.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.39
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$155.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.01
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.56
|
| Rate for Payer: United Healthcare Commercial |
$130.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.56
|
| Rate for Payer: United Healthcare VA CCN |
$84.56
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$265.70 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.20
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$392.39 |
| Rate for Payer: Aetna of VT Commercial |
$337.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.39
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$155.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.01
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.56
|
| Rate for Payer: United Healthcare Commercial |
$130.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.56
|
| Rate for Payer: United Healthcare VA CCN |
$84.56
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.40
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.55
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare VA CCN |
$161.55
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$265.70 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.20
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
OP
|
$351.04
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
4501201501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna of VT Commercial |
$333.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$298.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.08
|
| Rate for Payer: Cash Price |
$175.52
|
| Rate for Payer: Cigna Commercial |
$280.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.97
|
| Rate for Payer: Multiplan Commercial |
$326.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$298.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.97
|
| Rate for Payer: United Healthcare Commercial |
$333.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.97
|
| Rate for Payer: United Healthcare VA CCN |
$157.97
|
|
|
RPR F/E/E/N/L/M 7.6CM-12.5 CM
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
9811201502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.40
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.55
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare VA CCN |
$161.55
|
|
|
RPR FEM HERNIA INIT BLOCKED
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
9824955301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$582.59 |
| Max. Negotiated Rate |
$1,678.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,678.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,600.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$600.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,600.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$815.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$965.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$965.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$669.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$965.86
|
| Rate for Payer: Cash Price |
$893.00
|
| Rate for Payer: Cash Price |
$893.00
|
| Rate for Payer: Cigna Commercial |
$1,063.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$989.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$989.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$582.60
|
| Rate for Payer: Multiplan Commercial |
$1,660.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$827.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$582.59
|
| Rate for Payer: United Healthcare Commercial |
$896.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.59
|
| Rate for Payer: United Healthcare VA CCN |
$582.59
|
|
|
RPR FEM HERNIA INIT BLOCKED
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
9824955301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,321.82 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,696.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,321.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,321.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,518.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,500.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,428.80
|
| Rate for Payer: Cash Price |
$893.00
|
| Rate for Payer: Cigna Commercial |
$1,428.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,428.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,428.80
|
| Rate for Payer: Multiplan Commercial |
$1,660.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,518.10
|
| Rate for Payer: United Healthcare Commercial |
$1,696.70
|
|
