|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$454.96
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
4501310101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$432.21 |
| Rate for Payer: Aetna of VT Commercial |
$432.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$201.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$273.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.69
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cigna Commercial |
$363.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.73
|
| Rate for Payer: Multiplan Commercial |
$423.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$386.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$204.73
|
| Rate for Payer: United Healthcare Commercial |
$432.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.73
|
| Rate for Payer: United Healthcare VA CCN |
$204.73
|
|
|
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
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9601310101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,150.86 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,477.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,150.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,150.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,321.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,306.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,244.00
|
| Rate for Payer: Cash Price |
$777.50
|
| Rate for Payer: Cigna Commercial |
$1,244.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,244.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,244.00
|
| Rate for Payer: Multiplan Commercial |
$1,446.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,321.75
|
| Rate for Payer: United Healthcare Commercial |
$1,477.25
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$454.96
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
4501310101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.72 |
| Max. Negotiated Rate |
$432.21 |
| Rate for Payer: Aetna of VT Commercial |
$432.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$336.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$336.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$382.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.97
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cigna Commercial |
$363.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.97
|
| Rate for Payer: Multiplan Commercial |
$423.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$386.72
|
| Rate for Payer: United Healthcare Commercial |
$432.21
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$814.11 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9821310101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$814.11 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Professional
|
Both
|
$1,555.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9601310101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$231.87 |
| Max. Negotiated Rate |
$1,461.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,461.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,393.12
|
| 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 |
$1,393.12
|
| 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 |
$777.50
|
| Rate for Payer: Cash Price |
$777.50
|
| 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 |
$1,446.15
|
| 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
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
5101310101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.87 |
| Max. Negotiated Rate |
$606.36 |
| Rate for Payer: Aetna of VT Commercial |
$427.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.63
|
| 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 |
$407.63
|
| 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 |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| 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 |
$423.15
|
| 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
|
$455.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
5101310101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.52 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Aetna of VT Commercial |
$432.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$201.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$273.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.73
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$423.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$386.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$204.75
|
| Rate for Payer: United Healthcare Commercial |
$432.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.75
|
| Rate for Payer: United Healthcare VA CCN |
$204.75
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9601310101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$688.71 |
| Max. Negotiated Rate |
$1,477.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,477.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,393.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$688.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,393.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$936.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,321.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,259.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$699.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,236.22
|
| Rate for Payer: Cash Price |
$777.50
|
| Rate for Payer: Cigna Commercial |
$1,244.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,244.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,244.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$699.75
|
| Rate for Payer: Multiplan Commercial |
$1,446.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,321.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$699.75
|
| Rate for Payer: United Healthcare Commercial |
$1,477.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$699.75
|
| Rate for Payer: United Healthcare VA CCN |
$699.75
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310101
|
|
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 2.6-7.5 CM
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310102
|
|
Hospital Revenue Code
|
981
|
| 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
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$606.36 |
| 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 |
$238.83
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9821310101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$487.19 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| 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 |
$487.19
|
| 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 |
$662.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$874.50
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare VA CCN |
$495.00
|
|
|
CMPLX RPR TRUNK 2.6-7.5 CM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9811310102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$487.19 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| 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 |
$487.19
|
| 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 |
$662.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$874.50
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare VA CCN |
$495.00
|
|
|
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
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9601310102
|
|
Hospital Revenue Code
|
960
|
| 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
|
$1,100.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
9601310102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$487.19 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| 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 |
$487.19
|
| 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 |
$662.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$874.50
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare VA CCN |
$495.00
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna of VT Commercial |
$389.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310201
|
|
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 ADDL 5CM/<
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$182.54 |
| 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 |
$67.92
|
| 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 |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9821310201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of VT Commercial |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$249.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.13
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.30
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.30
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.30
|
| Rate for Payer: United Healthcare VA CCN |
$186.30
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9821310201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$306.40 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of VT Commercial |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.20
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.90
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5101310201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$776.40 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,665.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$776.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,055.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$788.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,393.63
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cigna Commercial |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,402.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$788.85
|
| Rate for Payer: Multiplan Commercial |
$1,630.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,490.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$788.85
|
| Rate for Payer: United Healthcare Commercial |
$1,665.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$788.85
|
| Rate for Payer: United Healthcare VA CCN |
$788.85
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5101310201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$1,647.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,647.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$1,630.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
