|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$661.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$630.40
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$349.01 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$474.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$638.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$354.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$626.46
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare VA CCN |
$354.60
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$201.81 |
| Max. Negotiated Rate |
$740.72 |
| Rate for Payer: Aetna of VT Commercial |
$740.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$470.53
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$368.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$588.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$588.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$361.12
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.81
|
| Rate for Payer: United Healthcare Commercial |
$310.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.81
|
| Rate for Payer: United Healthcare VA CCN |
$201.81
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
IP
|
$1,024.69
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
4501204401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$758.37 |
| Max. Negotiated Rate |
$973.46 |
| Rate for Payer: Aetna of VT Commercial |
$973.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$758.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$758.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$870.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.75
|
| Rate for Payer: Cash Price |
$512.34
|
| Rate for Payer: Cigna Commercial |
$819.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.75
|
| Rate for Payer: Multiplan Commercial |
$952.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.99
|
| Rate for Payer: United Healthcare Commercial |
$973.46
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$349.01 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$474.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$638.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$354.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$626.46
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare VA CCN |
$354.60
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$201.81 |
| Max. Negotiated Rate |
$740.72 |
| Rate for Payer: Aetna of VT Commercial |
$740.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$470.53
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$368.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$588.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$588.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$361.12
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.81
|
| Rate for Payer: United Healthcare Commercial |
$310.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.81
|
| Rate for Payer: United Healthcare VA CCN |
$201.81
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
OP
|
$1,024.69
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
4501204401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$453.84 |
| Max. Negotiated Rate |
$973.46 |
| Rate for Payer: Aetna of VT Commercial |
$973.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$918.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$453.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$918.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$616.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$870.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$830.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$461.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$814.63
|
| Rate for Payer: Cash Price |
$512.34
|
| Rate for Payer: Cigna Commercial |
$819.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.11
|
| Rate for Payer: Multiplan Commercial |
$952.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$461.11
|
| Rate for Payer: United Healthcare Commercial |
$973.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.11
|
| Rate for Payer: United Healthcare VA CCN |
$461.11
|
|
|
RPR INTMD N-HF/GENIT7.6-12.5
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
9811204402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$661.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$630.40
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$431.83 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna of VT Commercial |
$926.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$431.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$586.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$789.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$438.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.12
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$828.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$438.75
|
| Rate for Payer: United Healthcare Commercial |
$926.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$438.75
|
| Rate for Payer: United Healthcare VA CCN |
$438.75
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$692.78
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
4501203501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$512.73 |
| Max. Negotiated Rate |
$658.14 |
| Rate for Payer: Aetna of VT Commercial |
$658.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$512.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$512.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$588.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$581.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$554.22
|
| Rate for Payer: Cash Price |
$346.39
|
| Rate for Payer: Cigna Commercial |
$554.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$554.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$554.22
|
| Rate for Payer: Multiplan Commercial |
$644.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$588.86
|
| Rate for Payer: United Healthcare Commercial |
$658.14
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$721.60 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna of VT Commercial |
$926.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$780.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$828.75
|
| Rate for Payer: United Healthcare Commercial |
$926.25
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$431.83 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna of VT Commercial |
$926.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$431.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$586.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$789.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$438.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.12
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$828.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$438.75
|
| Rate for Payer: United Healthcare Commercial |
$926.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$438.75
|
| Rate for Payer: United Healthcare VA CCN |
$438.75
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$916.50 |
| Rate for Payer: Aetna of VT Commercial |
$916.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$315.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$532.35
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$411.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$366.28
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$225.59
|
| Rate for Payer: United Healthcare Commercial |
$347.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.59
|
| Rate for Payer: United Healthcare VA CCN |
$225.59
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$721.60 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna of VT Commercial |
$926.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$828.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$780.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$828.75
|
| Rate for Payer: United Healthcare Commercial |
$926.25
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
9811203501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$916.50 |
| Rate for Payer: Aetna of VT Commercial |
$916.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$873.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$315.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$259.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$532.35
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$411.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$366.28
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$225.59
|
| Rate for Payer: United Healthcare Commercial |
$347.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.59
|
| Rate for Payer: United Healthcare VA CCN |
$225.59
|
|
|
RPR INTMD S/A/T/E 12.6-20.0CM
|
Facility
|
OP
|
$692.78
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
4501203501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.83 |
| Max. Negotiated Rate |
$658.14 |
| Rate for Payer: Aetna of VT Commercial |
$658.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$620.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$306.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$588.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$311.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$550.76
|
| Rate for Payer: Cash Price |
$346.39
|
| Rate for Payer: Cigna Commercial |
$554.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$554.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$554.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$311.75
|
| Rate for Payer: Multiplan Commercial |
$644.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$588.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$311.75
|
| Rate for Payer: United Healthcare Commercial |
$658.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$311.75
|
| Rate for Payer: United Healthcare VA CCN |
$311.75
|
|
|
RPR INTMD S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203101
|
|
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 S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$347.42
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
4501203101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.13 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna of VT Commercial |
$330.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.94
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna Commercial |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.94
|
| Rate for Payer: Multiplan Commercial |
$323.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.31
|
| Rate for Payer: United Healthcare Commercial |
$330.05
|
|
|
RPR INTMD S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203102
|
|
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 S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.55 |
| 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 |
$147.86
|
| 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 |
$200.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.27
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$262.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$402.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$402.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$247.94
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$220.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare VA CCN |
$143.55
|
|
|
RPR INTMD S/A/T/E 2.5 CM/<
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203101
|
|
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 S/A/T/E 2.5 CM/<
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.55 |
| 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 |
$147.86
|
| 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 |
$200.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.27
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$262.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$402.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$402.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$247.94
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare Commercial |
$220.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.55
|
| Rate for Payer: United Healthcare VA CCN |
$143.55
|
|
|
RPR INTMD S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
9811203102
|
|
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 S/A/T/E 2.5 CM/<
|
Facility
|
OP
|
$347.42
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
4501203101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.87 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna of VT Commercial |
$330.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.20
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna Commercial |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.34
|
| Rate for Payer: Multiplan Commercial |
$323.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.34
|
| Rate for Payer: United Healthcare Commercial |
$330.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.34
|
| Rate for Payer: United Healthcare VA CCN |
$156.34
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.13 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna of VT Commercial |
$671.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$572.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$318.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.07
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$565.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.15
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare VA CCN |
$318.15
|
|
