|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$187.79 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna of VT Commercial |
$402.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$379.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$360.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$343.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.08
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$339.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$394.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$360.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.80
|
| Rate for Payer: United Healthcare Commercial |
$402.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.80
|
| Rate for Payer: United Healthcare VA CCN |
$190.80
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna of VT Commercial |
$201.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.54
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare Commercial |
$201.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare VA CCN |
$95.40
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
5109948701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: Aetna of VT Commercial |
$199.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.47
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$92.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.14
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare Commercial |
$130.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.82
|
| Rate for Payer: United Healthcare VA CCN |
$84.82
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
9609948701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna of VT Commercial |
$402.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$313.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$360.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$356.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.20
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$339.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$394.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$360.40
|
| Rate for Payer: United Healthcare Commercial |
$402.80
|
|
|
CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
5109948701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna of VT Commercial |
$201.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.54
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$197.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare Commercial |
$201.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.40
|
| Rate for Payer: United Healthcare VA CCN |
$95.40
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.62 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
5109948901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
5109948901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$119.44 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.62
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.33
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$71.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare VA CCN |
$46.20
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.80
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare VA CCN |
$108.00
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna of VT Commercial |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.62
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.33
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$71.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare VA CCN |
$46.20
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$119.44 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.62
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.33
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$71.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare VA CCN |
$46.20
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
9609948902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
CPLX CHRNC CARE EA ADDL 30
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
5109948901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
C-REACTIVE PROTEIN
|
Facility
|
OP
|
$72.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
3008614001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$68.76 |
| Rate for Payer: Aetna of VT Commercial |
$68.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.54
|
| Rate for Payer: Cash Price |
$36.19
|
| Rate for Payer: Cash Price |
$36.19
|
| Rate for Payer: Cigna Commercial |
$57.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.57
|
| Rate for Payer: Multiplan Commercial |
$67.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.57
|
| Rate for Payer: United Healthcare Commercial |
$68.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$32.57
|
|
|
C-REACTIVE PROTEIN
|
Facility
|
IP
|
$72.38
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
3008614001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$68.76 |
| Rate for Payer: Aetna of VT Commercial |
$68.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.90
|
| Rate for Payer: Cash Price |
$36.19
|
| Rate for Payer: Cigna Commercial |
$57.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.90
|
| Rate for Payer: Multiplan Commercial |
$67.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.52
|
| Rate for Payer: United Healthcare Commercial |
$68.76
|
|
|
C-REACTIVE PROTEIN HIGH SENSIT
|
Facility
|
OP
|
$89.18
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
3008614101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$84.72 |
| Rate for Payer: Aetna of VT Commercial |
$84.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.90
|
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Cigna Commercial |
$71.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.13
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.13
|
| Rate for Payer: United Healthcare Commercial |
$84.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare VA CCN |
$40.13
|
|
|
C-REACTIVE PROTEIN HIGH SENSIT
|
Facility
|
IP
|
$89.18
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
3008614101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$84.72 |
| Rate for Payer: Aetna of VT Commercial |
$84.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.34
|
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Cigna Commercial |
$71.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.34
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.80
|
| Rate for Payer: United Healthcare Commercial |
$84.72
|
|
|
C-REACTIVE PROTEIN HIGH SENSIT
|
Professional
|
Both
|
$89.18
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
3008614101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$83.83 |
| Rate for Payer: Aetna of VT Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.13
|
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare Commercial |
$19.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare VA CCN |
$12.95
|
|
|
CREATE EARDRUM OPENING
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
9826943601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$756.70 |
| Rate for Payer: Aetna of VT Commercial |
$756.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$212.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.97
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$241.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.78
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$215.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.78
|
| Rate for Payer: United Healthcare Commercial |
$233.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.78
|
| Rate for Payer: United Healthcare VA CCN |
$151.78
|
|
|
CREATE EARDRUM OPENING
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
3606943601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$756.70 |
| Rate for Payer: Aetna of VT Commercial |
$756.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$212.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.97
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$241.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.78
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$215.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.78
|
| Rate for Payer: United Healthcare Commercial |
$233.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.78
|
| Rate for Payer: United Healthcare VA CCN |
$151.78
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
3606943601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.78 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Aetna of VT Commercial |
$764.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$595.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$595.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$684.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$644.00
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$684.25
|
| Rate for Payer: United Healthcare Commercial |
$764.75
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
3606943601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.53 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Aetna of VT Commercial |
$764.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$356.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$484.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$684.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$652.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$362.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$639.98
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$644.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$362.25
|
| Rate for Payer: United Healthcare Commercial |
$764.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.25
|
| Rate for Payer: United Healthcare VA CCN |
$362.25
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
9826943601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$356.53 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Aetna of VT Commercial |
$764.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$356.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$721.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$484.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$684.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$652.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$362.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$639.98
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$644.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$684.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$362.25
|
| Rate for Payer: United Healthcare Commercial |
$764.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.25
|
| Rate for Payer: United Healthcare VA CCN |
$362.25
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
9826943601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$595.78 |
| Max. Negotiated Rate |
$764.75 |
| Rate for Payer: Aetna of VT Commercial |
$764.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$595.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$595.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$684.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$644.00
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$644.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$748.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$684.25
|
| Rate for Payer: United Healthcare Commercial |
$764.75
|
|
