|
RPR FEM HERNIA INIT BLOCKED
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
9824955301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$791.02 |
| 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 |
$1,600.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$791.02
|
| 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 |
$1,075.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,518.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,446.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$803.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,419.87
|
| 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: Martins Point Health Care Commercial |
$803.70
|
| Rate for Payer: Multiplan Commercial |
$1,660.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,518.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$803.70
|
| Rate for Payer: United Healthcare Commercial |
$1,696.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$803.70
|
| Rate for Payer: United Healthcare VA CCN |
$803.70
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$729.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$980.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$962.75
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.95
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare VA CCN |
$544.95
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
IP
|
$690.40
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
4501205501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.97 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Aetna of VT Commercial |
$655.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$510.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$510.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$586.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$579.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.32
|
| Rate for Payer: Cash Price |
$345.20
|
| Rate for Payer: Cigna Commercial |
$552.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$552.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$552.32
|
| Rate for Payer: Multiplan Commercial |
$642.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$586.84
|
| Rate for Payer: United Healthcare Commercial |
$655.88
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
OP
|
$690.40
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
4501205501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.78 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Aetna of VT Commercial |
$655.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$618.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$305.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$618.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$415.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$586.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$559.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$310.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$548.87
|
| Rate for Payer: Cash Price |
$345.20
|
| Rate for Payer: Cigna Commercial |
$552.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$552.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$552.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$310.68
|
| Rate for Payer: Multiplan Commercial |
$642.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$586.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.68
|
| Rate for Payer: United Healthcare Commercial |
$655.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.68
|
| Rate for Payer: United Healthcare VA CCN |
$310.68
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$280.39 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$392.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$322.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.60
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$514.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$771.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$771.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.54
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$280.39
|
| Rate for Payer: United Healthcare Commercial |
$431.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.39
|
| Rate for Payer: United Healthcare VA CCN |
$280.39
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$280.39 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$288.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$392.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$322.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.60
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$514.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$771.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$771.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.54
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$280.39
|
| Rate for Payer: United Healthcare Commercial |
$431.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.39
|
| Rate for Payer: United Healthcare VA CCN |
$280.39
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$896.26 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,017.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$729.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$980.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$962.75
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.95
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare VA CCN |
$544.95
|
|
|
RPR INTMD FACE/MM 12.6-20 CM
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
9811205502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$896.26 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,017.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$299.40 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna of VT Commercial |
$642.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$547.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$537.42
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$540.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$304.20
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare Commercial |
$642.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare VA CCN |
$304.20
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$635.44 |
| Rate for Payer: Aetna of VT Commercial |
$635.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$368.01
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$292.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$266.84
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.88
|
| Rate for Payer: United Healthcare Commercial |
$245.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.88
|
| Rate for Payer: United Healthcare VA CCN |
$159.88
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
IP
|
$643.35
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
4501205101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.14 |
| Max. Negotiated Rate |
$611.18 |
| Rate for Payer: Aetna of VT Commercial |
$611.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$546.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$540.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.68
|
| Rate for Payer: Cash Price |
$321.68
|
| Rate for Payer: Cigna Commercial |
$514.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.68
|
| Rate for Payer: Multiplan Commercial |
$598.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$546.85
|
| Rate for Payer: United Healthcare Commercial |
$611.18
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$299.40 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna of VT Commercial |
$642.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$299.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$406.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$547.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$537.42
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$540.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$304.20
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare Commercial |
$642.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare VA CCN |
$304.20
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$500.31 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna of VT Commercial |
$642.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$500.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$500.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$567.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.80
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$540.80
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.60
|
| Rate for Payer: United Healthcare Commercial |
$642.20
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$635.44 |
| Rate for Payer: Aetna of VT Commercial |
$635.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$605.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$368.01
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$292.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$266.84
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.88
|
| Rate for Payer: United Healthcare Commercial |
$245.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.88
|
| Rate for Payer: United Healthcare VA CCN |
$159.88
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
9811205102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$500.31 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna of VT Commercial |
$642.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$500.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$500.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$567.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.80
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$540.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$540.80
|
| Rate for Payer: Multiplan Commercial |
$628.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$574.60
|
| Rate for Payer: United Healthcare Commercial |
$642.20
|
|
|
RPR INTMD FACE/MM 2.5 CM/<
|
Facility
|
OP
|
$643.35
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
4501205101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.94 |
| Max. Negotiated Rate |
$611.18 |
| Rate for Payer: Aetna of VT Commercial |
$611.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$576.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$284.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$576.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$387.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$546.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$521.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$289.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$511.46
|
| Rate for Payer: Cash Price |
$321.68
|
| Rate for Payer: Cigna Commercial |
$514.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.51
|
| Rate for Payer: Multiplan Commercial |
$598.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$546.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$289.51
|
| Rate for Payer: United Healthcare Commercial |
$611.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.51
|
| Rate for Payer: United Healthcare VA CCN |
$289.51
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9601205202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.64 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.35
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$484.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$484.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$297.84
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare Commercial |
$290.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare VA CCN |
$188.64
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
5101205201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$328.63 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$328.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$446.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$589.89
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.90
|
| Rate for Payer: United Healthcare VA CCN |
$333.90
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9601205202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
5101205201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.64 |
| Max. Negotiated Rate |
$697.48 |
| Rate for Payer: Aetna of VT Commercial |
$697.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.35
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$484.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$484.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$297.84
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare Commercial |
$290.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare VA CCN |
$188.64
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9811205201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9811205202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9811205202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.64 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.35
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$484.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$484.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$297.84
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare Commercial |
$290.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.64
|
| Rate for Payer: United Healthcare VA CCN |
$188.64
|
|
|
RPR INTMD FACE/MM 2.6-5.0 CM
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
9601205202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
