|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200102
|
|
Hospital Revenue Code
|
960
|
| 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
|
$291.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
5101200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.37 |
| 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 |
$215.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$244.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.80
|
| 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: Multiplan Commercial |
$270.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$247.35
|
| Rate for Payer: United Healthcare Commercial |
$276.45
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200102
|
|
Hospital Revenue Code
|
960
|
| 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/<
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
9601200102
|
|
Hospital Revenue Code
|
960
|
| 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/TRNK2.6-7.5CM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
5101200201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna of VT Commercial |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.84
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$60.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare VA CCN |
$53.41
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$337.93 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Aetna of VT Commercial |
$724.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$683.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$683.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$459.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$648.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$618.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$606.59
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$610.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$610.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$610.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$343.35
|
| Rate for Payer: Multiplan Commercial |
$709.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$648.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$343.35
|
| Rate for Payer: United Healthcare Commercial |
$724.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$343.35
|
| Rate for Payer: United Healthcare VA CCN |
$343.35
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
5101200201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$310.84 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$717.22 |
| Rate for Payer: Aetna of VT Commercial |
$717.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$683.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$683.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.84
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$60.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$709.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare VA CCN |
$53.41
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$323.36 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.84
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$60.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare VA CCN |
$53.41
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
5101200201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of VT Commercial |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.90
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$336.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$336.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$390.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$357.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$399.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.00
|
| Rate for Payer: United Healthcare VA CCN |
$189.00
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$323.36 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.84
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$60.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare VA CCN |
$53.41
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$152.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.48
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.80
|
| Rate for Payer: United Healthcare VA CCN |
$154.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$323.36 |
| Rate for Payer: Aetna of VT Commercial |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.84
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$60.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.41
|
| Rate for Payer: United Healthcare VA CCN |
$53.41
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$419.09
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
4501200201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.17 |
| Max. Negotiated Rate |
$398.14 |
| Rate for Payer: Aetna of VT Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$356.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$335.27
|
| Rate for Payer: Cash Price |
$209.54
|
| Rate for Payer: Cigna Commercial |
$335.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$335.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$335.27
|
| Rate for Payer: Multiplan Commercial |
$389.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.23
|
| Rate for Payer: United Healthcare Commercial |
$398.14
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$419.09
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
4501200201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.61 |
| Max. Negotiated Rate |
$398.14 |
| Rate for Payer: Aetna of VT Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$185.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$356.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$188.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.18
|
| Rate for Payer: Cash Price |
$209.54
|
| Rate for Payer: Cigna Commercial |
$335.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$335.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$335.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$188.59
|
| Rate for Payer: Multiplan Commercial |
$389.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.59
|
| Rate for Payer: United Healthcare Commercial |
$398.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.59
|
| Rate for Payer: United Healthcare VA CCN |
$188.59
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9811200202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$254.59 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna of VT Commercial |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$292.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.20
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$275.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$275.20
|
| Rate for Payer: Multiplan Commercial |
$319.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$292.40
|
| Rate for Payer: United Healthcare Commercial |
$326.80
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
9601200201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$564.70 |
| Max. Negotiated Rate |
$724.85 |
| Rate for Payer: Aetna of VT Commercial |
$724.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$564.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$564.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$648.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$640.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$610.40
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$610.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$610.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$610.40
|
| Rate for Payer: Multiplan Commercial |
$709.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$648.55
|
| Rate for Payer: United Healthcare Commercial |
$724.85
|
|
|
RPR UMBIL HERN REDUC > 5 YR
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
9824958501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$828.91 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,064.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$828.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$828.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$952.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$940.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$896.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$896.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$896.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$896.00
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.00
|
| Rate for Payer: United Healthcare Commercial |
$1,064.00
|
|
|
RPR UMBIL HERN REDUC > 5 YR
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
9824958501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$1,052.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,052.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,003.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,003.41
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare Commercial |
$952.00
|
| Rate for Payer: United Healthcare VA CCN |
$448.00
|
|
|
RPR UMBIL HERN REDUC > 5 YR
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
9824958501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$496.05 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,064.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,003.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$496.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,003.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$952.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$907.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$890.40
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$896.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$896.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$896.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$952.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$504.00
|
| Rate for Payer: United Healthcare Commercial |
$1,064.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$504.00
|
| Rate for Payer: United Healthcare VA CCN |
$504.00
|
|
|
RPR VENTRAL HERN INIT BLOCK
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
9824956101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,076.25 |
| Max. Negotiated Rate |
$2,308.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,308.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,177.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,076.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,177.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,462.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,065.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,968.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,093.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,931.85
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cigna Commercial |
$1,944.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,944.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,944.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,093.50
|
| Rate for Payer: Multiplan Commercial |
$2,259.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,065.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,093.50
|
| Rate for Payer: United Healthcare Commercial |
$2,308.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,093.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,093.50
|
|
