|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$620.94 |
| 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 |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$704.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$671.20
|
| 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: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$713.15
|
| Rate for Payer: United Healthcare Commercial |
$797.05
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$682.18
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
4501200601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.14 |
| Max. Negotiated Rate |
$648.07 |
| Rate for Payer: Aetna of VT Commercial |
$648.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$410.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$579.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$306.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.33
|
| Rate for Payer: Cash Price |
$341.09
|
| Rate for Payer: Cigna Commercial |
$545.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$306.98
|
| Rate for Payer: Multiplan Commercial |
$634.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$579.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$306.98
|
| Rate for Payer: United Healthcare Commercial |
$648.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.98
|
| Rate for Payer: United Healthcare VA CCN |
$306.98
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$682.18
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
4501200601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$504.88 |
| Max. Negotiated Rate |
$648.07 |
| Rate for Payer: Aetna of VT Commercial |
$648.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$579.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.74
|
| Rate for Payer: Cash Price |
$341.09
|
| Rate for Payer: Cigna Commercial |
$545.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.74
|
| Rate for Payer: Multiplan Commercial |
$634.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$579.85
|
| Rate for Payer: United Healthcare Commercial |
$648.07
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$620.94 |
| 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 |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$704.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$671.20
|
| 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: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$713.15
|
| Rate for Payer: United Healthcare Commercial |
$797.05
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200601
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$788.66 |
| Rate for Payer: Aetna of VT Commercial |
$788.66
|
| 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 |
$108.11
|
| 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 |
$146.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$445.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.33
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$192.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.96
|
| Rate for Payer: United Healthcare Commercial |
$161.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.96
|
| Rate for Payer: United Healthcare VA CCN |
$104.96
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$788.66 |
| Rate for Payer: Aetna of VT Commercial |
$788.66
|
| 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 |
$108.11
|
| 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 |
$146.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$445.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$445.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.33
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$192.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$780.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.96
|
| Rate for Payer: United Healthcare Commercial |
$161.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.96
|
| Rate for Payer: United Healthcare VA CCN |
$104.96
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
9811200601
|
|
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
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
9811200402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$66.37 |
| Max. Negotiated Rate |
$287.39 |
| Rate for Payer: Aetna of VT Commercial |
$259.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.39
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$75.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.18
|
| Rate for Payer: Multiplan Commercial |
$256.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.37
|
| Rate for Payer: United Healthcare VA CCN |
$66.37
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
9811200402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$204.27 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna of VT Commercial |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$256.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$234.60
|
| Rate for Payer: United Healthcare Commercial |
$262.20
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$356.32
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
4501200401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$338.50 |
| Rate for Payer: Aetna of VT Commercial |
$338.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.27
|
| Rate for Payer: Cash Price |
$178.16
|
| Rate for Payer: Cigna Commercial |
$285.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.34
|
| Rate for Payer: Multiplan Commercial |
$331.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.34
|
| Rate for Payer: United Healthcare Commercial |
$338.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.34
|
| Rate for Payer: United Healthcare VA CCN |
$160.34
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
9811200402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$122.24 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna of VT Commercial |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.42
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$256.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$234.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.20
|
| Rate for Payer: United Healthcare Commercial |
$262.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.20
|
| Rate for Payer: United Healthcare VA CCN |
$124.20
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$356.32
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
4501200401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.71 |
| Max. Negotiated Rate |
$338.50 |
| Rate for Payer: Aetna of VT Commercial |
$338.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.06
|
| Rate for Payer: Cash Price |
$178.16
|
| Rate for Payer: Cigna Commercial |
$285.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.06
|
| Rate for Payer: Multiplan Commercial |
$331.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.87
|
| Rate for Payer: United Healthcare Commercial |
$338.50
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
5101200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Aetna of VT Commercial |
$276.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.34
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$232.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.95
|
| Rate for Payer: Multiplan Commercial |
$270.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.95
|
| Rate for Payer: United Healthcare Commercial |
$276.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.95
|
| Rate for Payer: United Healthcare VA CCN |
$130.95
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
5101200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$273.54 |
| Rate for Payer: Aetna of VT Commercial |
$273.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.78
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$46.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.31
|
| Rate for Payer: Multiplan Commercial |
$270.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare Commercial |
$62.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare VA CCN |
$40.77
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.32 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna of VT Commercial |
$616.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$480.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$480.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.20
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.20
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.65
|
| Rate for Payer: United Healthcare Commercial |
$616.55
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$336.52 |
| Rate for Payer: Aetna of VT Commercial |
$336.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.78
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$46.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.31
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare Commercial |
$62.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare VA CCN |
$40.77
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$287.44 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna of VT Commercial |
$616.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$292.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.96
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$519.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$519.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$292.05
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$292.05
|
| Rate for Payer: United Healthcare Commercial |
$616.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.05
|
| Rate for Payer: United Healthcare VA CCN |
$292.05
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.16
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.05
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare VA CCN |
$94.05
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.40
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.20
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$610.06 |
| Rate for Payer: Aetna of VT Commercial |
$610.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$581.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.78
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$46.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.31
|
| Rate for Payer: Multiplan Commercial |
$603.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare Commercial |
$62.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare VA CCN |
$40.77
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.61
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.10
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare VA CCN |
$161.10
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$290.44
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
4501200101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.95 |
| Max. Negotiated Rate |
$275.92 |
| Rate for Payer: Aetna of VT Commercial |
$275.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.35
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cigna Commercial |
$232.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.35
|
| Rate for Payer: Multiplan Commercial |
$270.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.87
|
| Rate for Payer: United Healthcare Commercial |
$275.92
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9811200101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$223.78 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.78
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$46.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.31
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare Commercial |
$62.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.77
|
| Rate for Payer: United Healthcare VA CCN |
$40.77
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$290.44
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
4501200101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.64 |
| Max. Negotiated Rate |
$275.92 |
| Rate for Payer: Aetna of VT Commercial |
$275.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$260.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$260.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.90
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cigna Commercial |
$232.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$232.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$232.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.70
|
| Rate for Payer: Multiplan Commercial |
$270.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.70
|
| Rate for Payer: United Healthcare Commercial |
$275.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.70
|
| Rate for Payer: United Healthcare VA CCN |
$130.70
|
|
