|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
5104218001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$748.24 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Aetna of VT Commercial |
$960.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$849.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$808.80
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.35
|
| Rate for Payer: United Healthcare Commercial |
$960.45
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$1,010.74
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
4504218001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$447.66 |
| Max. Negotiated Rate |
$960.20 |
| Rate for Payer: Aetna of VT Commercial |
$960.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$447.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$608.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.54
|
| Rate for Payer: Cash Price |
$505.37
|
| Rate for Payer: Cigna Commercial |
$808.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.83
|
| Rate for Payer: Multiplan Commercial |
$939.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.83
|
| Rate for Payer: United Healthcare Commercial |
$960.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.83
|
| Rate for Payer: United Healthcare VA CCN |
$454.83
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$501.79 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$569.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.40
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$300.29 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.01
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.10
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare VA CCN |
$305.10
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$747.62 |
| 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 |
$1,512.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$747.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,512.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,016.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,434.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,367.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$759.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,341.96
|
| 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: Martins Point Health Care Commercial |
$759.60
|
| Rate for Payer: Multiplan Commercial |
$1,569.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,434.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$759.60
|
| Rate for Payer: United Healthcare Commercial |
$1,603.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.60
|
| Rate for Payer: United Healthcare VA CCN |
$759.60
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$300.29 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.01
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.10
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare VA CCN |
$305.10
|
|
|
RPR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
5104218001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.82 |
| Max. Negotiated Rate |
$950.34 |
| Rate for Payer: Aetna of VT Commercial |
$950.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.87
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.49
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare Commercial |
$273.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare VA CCN |
$177.82
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
5104218001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.77 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Aetna of VT Commercial |
$960.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$447.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$905.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$608.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$803.75
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.95
|
| Rate for Payer: Multiplan Commercial |
$940.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.95
|
| Rate for Payer: United Healthcare Commercial |
$960.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.95
|
| Rate for Payer: United Healthcare VA CCN |
$454.95
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$300.29 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$549.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$539.01
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.10
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.10
|
| Rate for Payer: United Healthcare VA CCN |
$305.10
|
|
|
RPR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.82 |
| Max. Negotiated Rate |
$637.32 |
| Rate for Payer: Aetna of VT Commercial |
$637.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.87
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.49
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare Commercial |
$273.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare VA CCN |
$177.82
|
|
|
RPR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.82 |
| Max. Negotiated Rate |
$1,586.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,586.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,512.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,512.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.87
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.49
|
| Rate for Payer: Multiplan Commercial |
$1,569.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare Commercial |
$273.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare VA CCN |
$177.82
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$501.79 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$569.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.40
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
|
|
RPR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9604218002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.82 |
| Max. Negotiated Rate |
$637.32 |
| Rate for Payer: Aetna of VT Commercial |
$637.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.87
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.49
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare Commercial |
$273.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare VA CCN |
$177.82
|
|
|
RPR LACERATION PALATE </2 CM
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$177.82 |
| Max. Negotiated Rate |
$637.32 |
| Rate for Payer: Aetna of VT Commercial |
$637.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$607.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.87
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$239.49
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare Commercial |
$273.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.82
|
| Rate for Payer: United Healthcare VA CCN |
$177.82
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$1,010.74
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
4504218001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.05 |
| Max. Negotiated Rate |
$960.20 |
| Rate for Payer: Aetna of VT Commercial |
$960.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$859.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$849.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$808.59
|
| Rate for Payer: Cash Price |
$505.37
|
| Rate for Payer: Cigna Commercial |
$808.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$808.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$808.59
|
| Rate for Payer: Multiplan Commercial |
$939.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$859.13
|
| Rate for Payer: United Healthcare Commercial |
$960.20
|
|
|
RPR LACERATION PALATE </2 CM
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
9814218002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$501.79 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna of VT Commercial |
$644.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$501.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$569.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.40
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$542.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$542.40
|
| Rate for Payer: Multiplan Commercial |
$630.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.30
|
| Rate for Payer: United Healthcare Commercial |
$644.10
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$504.01 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Aetna of VT Commercial |
$646.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$572.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.80
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.80
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.85
|
| Rate for Payer: United Healthcare Commercial |
$646.95
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$504.01 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Aetna of VT Commercial |
$646.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$572.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.80
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.80
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.85
|
| Rate for Payer: United Healthcare Commercial |
$646.95
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$301.61 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Aetna of VT Commercial |
$646.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$551.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$541.39
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.45
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.45
|
| Rate for Payer: United Healthcare Commercial |
$646.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.45
|
| Rate for Payer: United Healthcare VA CCN |
$306.45
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$640.14 |
| Rate for Payer: Aetna of VT Commercial |
$640.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$358.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.25
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$156.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.03
|
| Rate for Payer: United Healthcare Commercial |
$130.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.03
|
| Rate for Payer: United Healthcare VA CCN |
$85.03
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$393.95
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
4501200501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$374.25 |
| Rate for Payer: Aetna of VT Commercial |
$374.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$177.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$313.19
|
| Rate for Payer: Cash Price |
$196.98
|
| Rate for Payer: Cigna Commercial |
$315.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.28
|
| Rate for Payer: Multiplan Commercial |
$366.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.28
|
| Rate for Payer: United Healthcare Commercial |
$374.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.28
|
| Rate for Payer: United Healthcare VA CCN |
$177.28
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$301.61 |
| Max. Negotiated Rate |
$646.95 |
| Rate for Payer: Aetna of VT Commercial |
$646.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$301.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$409.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$578.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$551.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$541.39
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$544.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$544.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.45
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$578.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.45
|
| Rate for Payer: United Healthcare Commercial |
$646.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.45
|
| Rate for Payer: United Healthcare VA CCN |
$306.45
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$393.95
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
4501200501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$374.25 |
| Rate for Payer: Aetna of VT Commercial |
$374.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.16
|
| Rate for Payer: Cash Price |
$196.98
|
| Rate for Payer: Cigna Commercial |
$315.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.16
|
| Rate for Payer: Multiplan Commercial |
$366.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.86
|
| Rate for Payer: United Healthcare Commercial |
$374.25
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
9811200502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$640.14 |
| Rate for Payer: Aetna of VT Commercial |
$640.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$610.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$358.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.25
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$156.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$633.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.03
|
| Rate for Payer: United Healthcare Commercial |
$130.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.03
|
| Rate for Payer: United Healthcare VA CCN |
$85.03
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$371.59 |
| Max. Negotiated Rate |
$797.05 |
| Rate for Payer: Aetna of VT Commercial |
$797.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$751.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$751.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$505.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$667.00
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$671.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$671.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$377.55
|
| Rate for Payer: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$713.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$377.55
|
| Rate for Payer: United Healthcare Commercial |
$797.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.55
|
| Rate for Payer: United Healthcare VA CCN |
$377.55
|
|
