|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
5101203201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$559.30 |
| Rate for Payer: Aetna of VT Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$253.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.27
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.09
|
| Rate for Payer: Multiplan Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare Commercial |
$278.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare VA CCN |
$180.81
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
5101203201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.53 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna of VT Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$263.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$358.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$473.02
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$565.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare VA CCN |
$267.75
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
5101203201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna of VT Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$476.00
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.75
|
| Rate for Payer: United Healthcare Commercial |
$565.25
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$576.21 |
| Max. Negotiated Rate |
$1,235.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,235.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,165.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$576.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,165.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$783.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,105.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,053.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$585.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,034.30
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,040.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,040.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,040.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$585.45
|
| Rate for Payer: Multiplan Commercial |
$1,209.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,105.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$585.45
|
| Rate for Payer: United Healthcare Commercial |
$1,235.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$585.45
|
| Rate for Payer: United Healthcare VA CCN |
$585.45
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$1,222.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,222.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,165.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,165.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$253.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.27
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.09
|
| Rate for Payer: Multiplan Commercial |
$1,209.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare Commercial |
$278.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare VA CCN |
$180.81
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$523.25 |
| 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 |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$565.60
|
| 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: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$664.58 |
| Rate for Payer: Aetna of VT Commercial |
$664.58
|
| 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 |
$186.23
|
| 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 |
$253.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.27
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.09
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare Commercial |
$278.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare VA CCN |
$180.81
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$523.25 |
| 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 |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$565.60
|
| 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: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$594.55
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
4501203201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.33 |
| Max. Negotiated Rate |
$564.82 |
| Rate for Payer: Aetna of VT Commercial |
$564.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$263.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$357.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$481.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$267.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$472.67
|
| Rate for Payer: Cash Price |
$297.28
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.55
|
| Rate for Payer: Multiplan Commercial |
$552.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$267.55
|
| Rate for Payer: United Healthcare Commercial |
$564.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.55
|
| Rate for Payer: United Healthcare VA CCN |
$267.55
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$523.25 |
| 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 |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$523.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$565.60
|
| 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: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$664.58 |
| Rate for Payer: Aetna of VT Commercial |
$664.58
|
| 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 |
$186.23
|
| 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 |
$253.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.27
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.09
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare Commercial |
$278.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare VA CCN |
$180.81
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$664.58 |
| Rate for Payer: Aetna of VT Commercial |
$664.58
|
| 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 |
$186.23
|
| 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 |
$253.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$402.27
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.09
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$256.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare Commercial |
$278.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.81
|
| Rate for Payer: United Healthcare VA CCN |
$180.81
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9601203201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$962.87 |
| Max. Negotiated Rate |
$1,235.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,235.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$962.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$962.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,105.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,092.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,040.80
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,040.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,040.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,040.80
|
| Rate for Payer: Multiplan Commercial |
$1,209.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,105.85
|
| Rate for Payer: United Healthcare Commercial |
$1,235.95
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203201
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
IP
|
$594.55
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
4501203201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.03 |
| Max. Negotiated Rate |
$564.82 |
| Rate for Payer: Aetna of VT Commercial |
$564.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$499.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.64
|
| Rate for Payer: Cash Price |
$297.28
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$552.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.37
|
| Rate for Payer: United Healthcare Commercial |
$564.82
|
|
|
RPR INTMD S/A/T/E 2.6-7.5 CM
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
9811203202
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$541.75 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$585.60
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$688.08 |
| Rate for Payer: Aetna of VT Commercial |
$688.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$222.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.41
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.56
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$297.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$541.75 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$585.60
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
IP
|
$723.80
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
4501203401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$535.68 |
| Max. Negotiated Rate |
$687.61 |
| Rate for Payer: Aetna of VT Commercial |
$687.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$607.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.04
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cigna Commercial |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.04
|
| Rate for Payer: Multiplan Commercial |
$673.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.23
|
| Rate for Payer: United Healthcare Commercial |
$687.61
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$723.80
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
4501203401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$687.61 |
| Rate for Payer: Aetna of VT Commercial |
$687.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$320.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$648.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$435.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$586.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$575.42
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cigna Commercial |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.71
|
| Rate for Payer: Multiplan Commercial |
$673.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.71
|
| Rate for Payer: United Healthcare Commercial |
$687.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.71
|
| Rate for Payer: United Healthcare VA CCN |
$325.71
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$440.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$592.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$581.94
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$329.40
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare VA CCN |
$329.40
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$688.08 |
| Rate for Payer: Aetna of VT Commercial |
$688.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$222.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.41
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.56
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$297.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
RPR INTMD S/A/T/E 7.6-12.5 CM
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9811203402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$440.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$592.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$581.94
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$329.40
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare VA CCN |
$329.40
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,249.29 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,603.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,249.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,249.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,434.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,350.40
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$1,350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,350.40
|
| Rate for Payer: Multiplan Commercial |
$1,569.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,434.80
|
| Rate for Payer: United Healthcare Commercial |
$1,603.60
|
|
