|
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
|
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
|
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 2.6-7.5 CM
|
Facility
|
IP
|
$3,984.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,948.56 |
| Max. Negotiated Rate |
$3,784.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,784.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,948.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,948.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,386.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,346.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,187.20
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cigna Commercial |
$3,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,187.20
|
| Rate for Payer: Multiplan Commercial |
$3,705.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,386.40
|
| Rate for Payer: United Healthcare Commercial |
$3,784.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
5101315201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,151.98 |
| Max. Negotiated Rate |
$2,470.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,151.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,565.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,106.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,067.80
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,170.45
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,170.45
|
| Rate for Payer: United Healthcare Commercial |
$2,470.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,170.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,170.45
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$612.97 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$612.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$833.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,121.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$622.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,100.28
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare VA CCN |
$622.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$612.97 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$612.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$833.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,121.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$622.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,100.28
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare VA CCN |
$622.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9821315201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$612.97 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$612.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$833.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,121.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$622.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,100.28
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$622.80
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.80
|
| Rate for Payer: United Healthcare VA CCN |
$622.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
5101315201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$2,470.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,925.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,184.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,080.80
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.80
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.85
|
| Rate for Payer: United Healthcare Commercial |
$2,470.95
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,024.30 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,162.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,107.20
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$2,600.51
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
4501315201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,924.64 |
| Max. Negotiated Rate |
$2,470.48 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,924.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,924.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,184.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,080.41
|
| Rate for Payer: Cash Price |
$1,300.26
|
| Rate for Payer: Cigna Commercial |
$2,080.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.41
|
| Rate for Payer: Multiplan Commercial |
$2,418.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.43
|
| Rate for Payer: United Healthcare Commercial |
$2,470.48
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$3,984.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$3,744.96 |
| Rate for Payer: Aetna of VT Commercial |
$3,744.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,569.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,569.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$3,705.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9821315201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,024.30 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,162.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,107.20
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$2,600.51
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
4501315201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,151.77 |
| Max. Negotiated Rate |
$2,470.48 |
| Rate for Payer: Aetna of VT Commercial |
$2,470.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,329.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,151.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,329.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,565.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,210.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,106.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,170.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,067.41
|
| Rate for Payer: Cash Price |
$1,300.26
|
| Rate for Payer: Cigna Commercial |
$2,080.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,080.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,080.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,170.23
|
| Rate for Payer: Multiplan Commercial |
$2,418.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,210.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,170.23
|
| Rate for Payer: United Healthcare Commercial |
$2,470.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,170.23
|
| Rate for Payer: United Healthcare VA CCN |
$1,170.23
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315201
|
|
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
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| 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 |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| 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: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
OP
|
$3,984.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,764.51 |
| Max. Negotiated Rate |
$3,784.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,784.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,569.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,764.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,569.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,398.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,386.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,792.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,167.28
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cigna Commercial |
$3,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,792.80
|
| Rate for Payer: Multiplan Commercial |
$3,705.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,386.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,792.80
|
| Rate for Payer: United Healthcare Commercial |
$3,784.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,792.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,792.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,024.30 |
| Max. Negotiated Rate |
$1,314.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,314.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,162.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,107.20
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,107.20
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,176.40
|
| Rate for Payer: United Healthcare Commercial |
$1,314.80
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$761.62 |
| 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 |
$322.95
|
| 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 |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$2,601.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
5101315201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$2,444.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,444.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,330.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$2,418.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9811315202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$1,300.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,300.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9601315202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$1,300.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,300.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
9821315201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$1,300.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,300.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$322.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,239.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$438.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$761.62
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cigna Commercial |
$573.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$760.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$760.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$466.43
|
| Rate for Payer: Multiplan Commercial |
$1,287.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$445.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare Commercial |
$482.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.54
|
| Rate for Payer: United Healthcare VA CCN |
$313.54
|
|
|
CMPLX RPR E/N/E/L ADDL 5CM/<
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
9811315301
|
|
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
|
|
