|
CLTX TOE JOINT DISLC W/O ANES
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9812866001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$212.33 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.33
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$170.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.71
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare Commercial |
$137.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare VA CCN |
$89.58
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9812866002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: Aetna of VT Commercial |
$300.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.33
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$170.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.71
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare Commercial |
$137.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.58
|
| Rate for Payer: United Healthcare VA CCN |
$89.58
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9812866001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
IP
|
$317.08
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
4502866001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.67 |
| Max. Negotiated Rate |
$301.23 |
| Rate for Payer: Aetna of VT Commercial |
$301.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.66
|
| Rate for Payer: Cash Price |
$158.54
|
| Rate for Payer: Cigna Commercial |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.66
|
| Rate for Payer: Multiplan Commercial |
$294.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.52
|
| Rate for Payer: United Healthcare Commercial |
$301.23
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
OP
|
$317.08
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
4502866001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$301.23 |
| Rate for Payer: Aetna of VT Commercial |
$301.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$284.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$284.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.08
|
| Rate for Payer: Cash Price |
$158.54
|
| Rate for Payer: Cigna Commercial |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.69
|
| Rate for Payer: Multiplan Commercial |
$294.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.69
|
| Rate for Payer: United Healthcare Commercial |
$301.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.69
|
| Rate for Payer: United Healthcare VA CCN |
$142.69
|
|
|
CLTX TOE JOINT DISLC W/O ANES
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9812866002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$236.83 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna of VT Commercial |
$304.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.00
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$272.00
|
| Rate for Payer: United Healthcare Commercial |
$304.00
|
|
|
CMBN ANT PST COLPRHY
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
9825726001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,465.40 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,881.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,465.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,465.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,683.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,663.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,584.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,584.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,584.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare Commercial |
$1,881.00
|
|
|
CMBN ANT PST COLPRHY
|
Professional
|
Both
|
$1,980.00
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
9825726001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$723.17 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,861.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,773.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$744.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,773.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,012.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,053.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$831.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.57
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,277.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,205.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,205.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$723.17
|
| Rate for Payer: Multiplan Commercial |
$1,841.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,026.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$723.17
|
| Rate for Payer: United Healthcare Commercial |
$1,112.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$723.17
|
| Rate for Payer: United Healthcare VA CCN |
$723.17
|
|
|
CMBN ANT PST COLPRHY
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
9825726001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$876.94 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,881.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,773.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$876.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,773.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,191.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,683.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,603.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,574.10
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,584.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,584.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,584.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,683.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$891.00
|
| Rate for Payer: United Healthcare Commercial |
$1,881.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$891.00
|
| Rate for Payer: United Healthcare VA CCN |
$891.00
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9601315102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$698.42 |
| Rate for Payer: Aetna of VT Commercial |
$698.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9821315101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$698.42 |
| Rate for Payer: Aetna of VT Commercial |
$698.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
5101315101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,064.26 |
| Max. Negotiated Rate |
$1,366.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,366.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,064.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,064.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,222.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,207.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,150.40
|
| Rate for Payer: Cash Price |
$719.00
|
| Rate for Payer: Cigna Commercial |
$1,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,150.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,150.40
|
| Rate for Payer: Multiplan Commercial |
$1,337.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,222.30
|
| Rate for Payer: United Healthcare Commercial |
$1,366.10
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9811315101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$329.07 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna of VT Commercial |
$705.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$329.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$447.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$631.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.68
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$594.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$334.35
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare VA CCN |
$334.35
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9821315101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$329.07 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna of VT Commercial |
$705.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$329.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$447.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$631.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.68
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$594.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$334.35
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare VA CCN |
$334.35
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9601315101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$965.96 |
| Max. Negotiated Rate |
$2,071.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,071.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,953.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$965.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,953.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,312.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,853.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,766.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$981.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,733.89
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,744.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,744.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,744.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$981.45
|
| Rate for Payer: Multiplan Commercial |
$2,028.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,853.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$981.45
|
| Rate for Payer: United Healthcare Commercial |
$2,071.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$981.45
|
| Rate for Payer: United Healthcare VA CCN |
$981.45
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
IP
|
$1,437.26
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
4501315101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.72 |
| Max. Negotiated Rate |
$1,365.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,063.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,063.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,221.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,207.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,149.81
|
| Rate for Payer: Cash Price |
$718.63
|
| Rate for Payer: Cigna Commercial |
$1,149.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,149.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,149.81
|
| Rate for Payer: Multiplan Commercial |
$1,336.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,221.67
|
| Rate for Payer: United Healthcare Commercial |
$1,365.40
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9601315102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$549.89 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna of VT Commercial |
$705.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$631.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$594.40
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$594.40
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.55
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9811315101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$698.42 |
| Rate for Payer: Aetna of VT Commercial |
$698.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9601315101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$2,050.14 |
| Rate for Payer: Aetna of VT Commercial |
$2,050.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,953.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,953.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$2,028.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9811315102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$698.42 |
| Rate for Payer: Aetna of VT Commercial |
$698.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9811315102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$329.07 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna of VT Commercial |
$705.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$329.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$447.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$631.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$334.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.68
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$594.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$334.35
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.35
|
| Rate for Payer: United Healthcare VA CCN |
$334.35
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Professional
|
Both
|
$1,438.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
5101315101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$260.73 |
| Max. Negotiated Rate |
$1,351.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,351.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,288.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,288.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$582.93
|
| Rate for Payer: Cash Price |
$719.00
|
| Rate for Payer: Cash Price |
$719.00
|
| Rate for Payer: Cigna Commercial |
$476.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$649.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$649.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$1,337.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare Commercial |
$401.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.73
|
| Rate for Payer: United Healthcare VA CCN |
$260.73
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9601315101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,614.16 |
| Max. Negotiated Rate |
$2,071.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,071.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,614.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,614.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,853.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,832.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,744.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,744.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,744.80
|
| Rate for Payer: Multiplan Commercial |
$2,028.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,853.85
|
| Rate for Payer: United Healthcare Commercial |
$2,071.95
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
OP
|
$1,437.26
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
4501315101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$1,365.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,287.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$636.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,287.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$865.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,221.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,164.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$646.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,142.62
|
| Rate for Payer: Cash Price |
$718.63
|
| Rate for Payer: Cigna Commercial |
$1,149.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,149.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,149.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$646.77
|
| Rate for Payer: Multiplan Commercial |
$1,336.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,221.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$646.77
|
| Rate for Payer: United Healthcare Commercial |
$1,365.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.77
|
| Rate for Payer: United Healthcare VA CCN |
$646.77
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
9811315101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.89 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna of VT Commercial |
$705.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$631.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$624.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$594.40
|
| Rate for Payer: Cash Price |
$371.50
|
| Rate for Payer: Cigna Commercial |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$594.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$594.40
|
| Rate for Payer: Multiplan Commercial |
$690.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.55
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
|
