|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$627.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
4501204101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.52 |
| Max. Negotiated Rate |
$596.26 |
| Rate for Payer: Aetna of VT Commercial |
$596.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$464.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$464.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$533.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$527.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$502.11
|
| Rate for Payer: Cash Price |
$313.82
|
| Rate for Payer: Cigna Commercial |
$502.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.11
|
| Rate for Payer: Multiplan Commercial |
$583.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$533.49
|
| Rate for Payer: United Healthcare Commercial |
$596.26
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$410.02 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.20
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$520.76 |
| Rate for Payer: Aetna of VT Commercial |
$520.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.51
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$250.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$404.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$404.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.79
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare VA CCN |
$137.66
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$245.37 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$333.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$448.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.43
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.30
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare VA CCN |
$249.30
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$245.37 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$333.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$448.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$440.43
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.30
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.30
|
| Rate for Payer: United Healthcare VA CCN |
$249.30
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$410.02 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Aetna of VT Commercial |
$526.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.20
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$443.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$443.20
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$470.90
|
| Rate for Payer: United Healthcare Commercial |
$526.30
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Facility
|
OP
|
$627.64
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
4501204101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.98 |
| Max. Negotiated Rate |
$596.26 |
| Rate for Payer: Aetna of VT Commercial |
$596.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$562.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$562.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$377.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$533.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$508.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.97
|
| Rate for Payer: Cash Price |
$313.82
|
| Rate for Payer: Cigna Commercial |
$502.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$583.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$533.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.44
|
| Rate for Payer: United Healthcare Commercial |
$596.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.44
|
| Rate for Payer: United Healthcare VA CCN |
$282.44
|
|
|
RPR INTMD N-HF/GENIT 2.5CM/<
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
9811204101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$520.76 |
| Rate for Payer: Aetna of VT Commercial |
$520.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.51
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$250.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$404.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$404.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.79
|
| Rate for Payer: Multiplan Commercial |
$515.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare Commercial |
$211.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.66
|
| Rate for Payer: United Healthcare VA CCN |
$137.66
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
5101204201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$474.40 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna of VT Commercial |
$608.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$474.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$474.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.80
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.80
|
| Rate for Payer: Multiplan Commercial |
$596.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.85
|
| Rate for Payer: United Healthcare Commercial |
$608.95
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.20
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$298.51 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.83
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$303.30
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare VA CCN |
$303.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$633.56 |
| Rate for Payer: Aetna of VT Commercial |
$633.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.63
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$338.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare Commercial |
$285.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare VA CCN |
$185.39
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$640.05
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
4501204201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.48 |
| Max. Negotiated Rate |
$608.05 |
| Rate for Payer: Aetna of VT Commercial |
$608.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$573.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$573.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$385.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$518.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.84
|
| Rate for Payer: Cash Price |
$320.02
|
| Rate for Payer: Cigna Commercial |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.02
|
| Rate for Payer: Multiplan Commercial |
$595.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.02
|
| Rate for Payer: United Healthcare Commercial |
$608.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.02
|
| Rate for Payer: United Healthcare VA CCN |
$288.02
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$633.56 |
| Rate for Payer: Aetna of VT Commercial |
$633.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.63
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$338.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare Commercial |
$285.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare VA CCN |
$185.39
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$298.51 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.83
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$303.30
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare VA CCN |
$303.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$298.51 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.83
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$303.30
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.30
|
| Rate for Payer: United Healthcare VA CCN |
$303.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.20
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
5101204201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.90 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna of VT Commercial |
$608.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$574.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$574.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$385.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$519.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$509.60
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.45
|
| Rate for Payer: Multiplan Commercial |
$596.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.45
|
| Rate for Payer: United Healthcare Commercial |
$608.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.45
|
| Rate for Payer: United Healthcare VA CCN |
$288.45
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$640.05
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
4501204201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$473.70 |
| Max. Negotiated Rate |
$608.05 |
| Rate for Payer: Aetna of VT Commercial |
$608.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$473.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.04
|
| Rate for Payer: Cash Price |
$320.02
|
| Rate for Payer: Cigna Commercial |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.04
|
| Rate for Payer: Multiplan Commercial |
$595.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.04
|
| Rate for Payer: United Healthcare Commercial |
$608.05
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$972.49 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,248.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$972.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$972.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,116.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,103.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,051.20
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$1,051.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,051.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$1,222.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,116.90
|
| Rate for Payer: United Healthcare Commercial |
$1,248.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$498.83 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna of VT Commercial |
$640.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.20
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$539.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$539.20
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.90
|
| Rate for Payer: United Healthcare Commercial |
$640.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$581.97 |
| Max. Negotiated Rate |
$1,248.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,248.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,177.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$581.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,177.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$791.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,116.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$591.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,044.63
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$1,051.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,051.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,051.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$591.30
|
| Rate for Payer: Multiplan Commercial |
$1,222.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,116.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$591.30
|
| Rate for Payer: United Healthcare Commercial |
$1,248.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$591.30
|
| Rate for Payer: United Healthcare VA CCN |
$591.30
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Professional
|
Both
|
$1,314.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9601204201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$1,235.16 |
| Rate for Payer: Aetna of VT Commercial |
$1,235.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,177.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,177.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.63
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$338.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$1,222.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare Commercial |
$285.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare VA CCN |
$185.39
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
5101204201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$602.54 |
| Rate for Payer: Aetna of VT Commercial |
$602.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$574.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$574.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.63
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$338.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$596.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare Commercial |
$285.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare VA CCN |
$185.39
|
|
|
RPR INTMD N-HF/GENIT2.6-7.5
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
9811204202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$633.56 |
| Rate for Payer: Aetna of VT Commercial |
$633.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.63
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$338.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$626.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare Commercial |
$285.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.39
|
| Rate for Payer: United Healthcare VA CCN |
$185.39
|
|
