|
CMPLX RPR S/A/L ADDL 5 CM/>
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
9811312202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$294.56 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna of VT Commercial |
$378.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$338.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$334.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.40
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.40
|
| Rate for Payer: Multiplan Commercial |
$370.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.30
|
| Rate for Payer: United Healthcare Commercial |
$378.10
|
|
|
CMPLX RPR S/A/L ADDL 5 CM/>
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
9811312201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$374.12 |
| Rate for Payer: Aetna of VT Commercial |
$374.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.39
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$139.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$193.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$193.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.20
|
| Rate for Payer: Multiplan Commercial |
$370.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.79
|
| Rate for Payer: United Healthcare Commercial |
$116.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.79
|
| Rate for Payer: United Healthcare VA CCN |
$75.79
|
|
|
CMPLX RPR S/A/L ADDL 5 CM/>
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
9811312201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$294.56 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna of VT Commercial |
$378.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$338.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$334.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.40
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$318.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.40
|
| Rate for Payer: Multiplan Commercial |
$370.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.30
|
| Rate for Payer: United Healthcare Commercial |
$378.10
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.91
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$421.65
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare VA CCN |
$421.65
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
5101310001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,014.68 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,014.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,151.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,096.80
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310001
|
|
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 TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9821310001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$188.69 |
| Max. Negotiated Rate |
$880.78 |
| Rate for Payer: Aetna of VT Commercial |
$880.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.69 |
| Max. Negotiated Rate |
$880.78 |
| Rate for Payer: Aetna of VT Commercial |
$880.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
5101310001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$607.22 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$607.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$825.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,110.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$616.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,089.94
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$616.95
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,165.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare Commercial |
$1,302.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$616.95
|
| Rate for Payer: United Healthcare VA CCN |
$616.95
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
5101310001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.69 |
| Max. Negotiated Rate |
$1,288.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,288.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$1,275.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$1,370.05
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
4501310001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,013.97 |
| Max. Negotiated Rate |
$1,301.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,301.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,013.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,013.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,164.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,150.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,096.04
|
| Rate for Payer: Cash Price |
$685.02
|
| Rate for Payer: Cigna Commercial |
$1,096.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.04
|
| Rate for Payer: Multiplan Commercial |
$1,274.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,164.54
|
| Rate for Payer: United Healthcare Commercial |
$1,301.55
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$522.01 |
| 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 |
$194.35
|
| 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 |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$693.47 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$749.60
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9821310001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$693.47 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$749.60
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.69 |
| Max. Negotiated Rate |
$880.78 |
| Rate for Payer: Aetna of VT Commercial |
$880.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$1,370.05
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
4501310001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$606.80 |
| Max. Negotiated Rate |
$1,301.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,301.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,227.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$606.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,227.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$824.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,164.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,109.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$616.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,089.19
|
| Rate for Payer: Cash Price |
$685.02
|
| Rate for Payer: Cigna Commercial |
$1,096.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,096.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,096.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$616.52
|
| Rate for Payer: Multiplan Commercial |
$1,274.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,164.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$616.52
|
| Rate for Payer: United Healthcare Commercial |
$1,301.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$616.52
|
| Rate for Payer: United Healthcare VA CCN |
$616.52
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.91
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$421.65
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare VA CCN |
$421.65
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$693.47 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$693.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$749.60
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9821310001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$415.00 |
| Max. Negotiated Rate |
$890.15 |
| Rate for Payer: Aetna of VT Commercial |
$890.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$839.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$796.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.91
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cigna Commercial |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$749.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$749.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$421.65
|
| Rate for Payer: Multiplan Commercial |
$871.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare Commercial |
$890.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.65
|
| Rate for Payer: United Healthcare VA CCN |
$421.65
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
IP
|
$2,307.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,707.41 |
| Max. Negotiated Rate |
$2,191.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,191.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,707.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,707.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,960.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,937.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$1,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,845.60
|
| Rate for Payer: Multiplan Commercial |
$2,145.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,960.95
|
| Rate for Payer: United Healthcare Commercial |
$2,191.65
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9811310001
|
|
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 TRUNK 1.1-2.5 CM
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.69 |
| Max. Negotiated Rate |
$2,168.58 |
| Rate for Payer: Aetna of VT Commercial |
$2,168.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,066.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,066.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.80
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$344.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.71
|
| Rate for Payer: Multiplan Commercial |
$2,145.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare Commercial |
$290.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.69
|
| Rate for Payer: United Healthcare VA CCN |
$188.69
|
|
|
CMPLX RPR TRUNK 1.1-2.5 CM
|
Facility
|
OP
|
$2,307.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
9601310001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,021.77 |
| Max. Negotiated Rate |
$2,191.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,191.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,066.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,021.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,066.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,960.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,868.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,038.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,834.07
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$1,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,845.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,845.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,038.15
|
| Rate for Payer: Multiplan Commercial |
$2,145.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,960.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,038.15
|
| Rate for Payer: United Healthcare Commercial |
$2,191.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,038.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,038.15
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9821310101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$231.87 |
| Max. Negotiated Rate |
$1,034.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,034.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$548.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$266.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$548.56
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$424.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$606.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$606.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$372.89
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.87
|
| Rate for Payer: United Healthcare Commercial |
$356.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.87
|
| Rate for Payer: United Healthcare VA CCN |
$231.87
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310101
|
|
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
|
|
