|
CREATINE KINASE TOTAL
|
Facility
|
OP
|
$100.58
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
3008255001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of VT Commercial |
$95.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.96
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.26
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.26
|
| Rate for Payer: United Healthcare Commercial |
$95.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.51
|
| Rate for Payer: United Healthcare VA CCN |
$45.26
|
|
|
CREATINE KINASE TOTAL
|
Professional
|
Both
|
$100.58
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
3008255001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna of VT Commercial |
$94.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.48
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.42
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$10.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.51
|
| Rate for Payer: United Healthcare VA CCN |
$6.51
|
|
|
CREATINE KINASE TOTAL
|
Facility
|
IP
|
$100.58
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
3008255001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of VT Commercial |
$95.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.46
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.49
|
| Rate for Payer: United Healthcare Commercial |
$95.55
|
|
|
CREATININE OTHER SOURCE
|
Professional
|
Both
|
$78.72
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3008257001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna of VT Commercial |
$74.00
|
| 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 |
$5.34
|
| 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 |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.13
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.11
|
| Rate for Payer: Multiplan Commercial |
$73.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$7.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$5.18
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
OP
|
$78.72
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3008257001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$74.78 |
| Rate for Payer: Aetna of VT Commercial |
$74.78
|
| 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 |
$34.87
|
| 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 |
$47.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.58
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cigna Commercial |
$62.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.42
|
| Rate for Payer: Multiplan Commercial |
$73.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.42
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$35.42
|
|
|
CREATININE OTHER SOURCE
|
Facility
|
IP
|
$78.72
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3008257001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.26 |
| Max. Negotiated Rate |
$74.78 |
| Rate for Payer: Aetna of VT Commercial |
$74.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.98
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cigna Commercial |
$62.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.98
|
| Rate for Payer: Multiplan Commercial |
$73.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.91
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
|
|
Critical Care 1 HR
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$1,330.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,330.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,255.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$620.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,255.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$843.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,190.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,134.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$630.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,113.80
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$1,120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,120.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$630.45
|
| Rate for Payer: Multiplan Commercial |
$1,302.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,190.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$630.45
|
| Rate for Payer: United Healthcare Commercial |
$1,330.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$630.45
|
| Rate for Payer: United Healthcare VA CCN |
$630.45
|
|
|
Critical Care 1 HR
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$1,316.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,316.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.29
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$108.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.95
|
| Rate for Payer: Multiplan Commercial |
$1,302.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare Commercial |
$152.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare VA CCN |
$99.42
|
|
|
Critical Care 1 HR
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,036.88 |
| Max. Negotiated Rate |
$1,330.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,330.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,036.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,036.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,190.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,176.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,120.80
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$1,120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,120.80
|
| Rate for Payer: Multiplan Commercial |
$1,302.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,190.85
|
| Rate for Payer: United Healthcare Commercial |
$1,330.95
|
|
|
Critical Care 1 hr. 30 mins.
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929203
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$930.53 |
| Max. Negotiated Rate |
$1,995.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,995.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,882.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$930.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,882.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,264.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,785.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,701.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$945.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,670.30
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$1,680.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,680.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,680.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$945.45
|
| Rate for Payer: Multiplan Commercial |
$1,953.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,785.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$945.45
|
| Rate for Payer: United Healthcare Commercial |
$1,995.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$945.45
|
| Rate for Payer: United Healthcare VA CCN |
$945.45
|
|
|
Critical Care 1 hr. 30 mins.
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929203
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,554.95 |
| Max. Negotiated Rate |
$1,995.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,995.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,554.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,554.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,785.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,764.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$1,680.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,680.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,680.80
|
| Rate for Payer: Multiplan Commercial |
$1,953.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,785.85
|
| Rate for Payer: United Healthcare Commercial |
$1,995.95
|
|
|
Critical Care 1 hr. 30 mins.
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929203
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$1,974.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,974.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.29
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cash Price |
$1,050.50
|
| Rate for Payer: Cigna Commercial |
$108.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.95
|
| Rate for Payer: Multiplan Commercial |
$1,953.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare Commercial |
$152.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare VA CCN |
$99.42
|
|
|
Critical Care 2 hrs.
|
Professional
|
Both
|
$2,801.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929204
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$2,632.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,632.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.29
|
| Rate for Payer: Cash Price |
$1,400.50
|
| Rate for Payer: Cash Price |
$1,400.50
|
| Rate for Payer: Cigna Commercial |
$108.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.95
|
| Rate for Payer: Multiplan Commercial |
$2,604.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare Commercial |
$152.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare VA CCN |
$99.42
|
|
|
Critical Care 2 hrs.
|
Facility
|
IP
|
$2,801.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929204
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2,073.02 |
| Max. Negotiated Rate |
$2,660.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,660.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,073.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,073.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,380.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,352.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,240.80
|
| Rate for Payer: Cash Price |
$1,400.50
|
| Rate for Payer: Cigna Commercial |
$2,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,240.80
|
| Rate for Payer: Multiplan Commercial |
$2,604.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,380.85
|
| Rate for Payer: United Healthcare Commercial |
$2,660.95
|
|
|
Critical Care 2 hrs.
|
Facility
|
OP
|
$2,801.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929204
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,240.56 |
| Max. Negotiated Rate |
$2,660.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,660.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,509.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,240.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,509.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,686.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,380.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,268.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,226.80
|
| Rate for Payer: Cash Price |
$1,400.50
|
| Rate for Payer: Cigna Commercial |
$2,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,240.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,260.45
|
| Rate for Payer: Multiplan Commercial |
$2,604.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,380.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,260.45
|
| Rate for Payer: United Healthcare Commercial |
$2,660.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,260.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,260.45
|
|
|
Critical Care 2hrs 30 mins >
|
Facility
|
OP
|
$3,501.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929205
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,550.59 |
| Max. Negotiated Rate |
$3,325.95 |
| Rate for Payer: Aetna of VT Commercial |
$3,325.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,136.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,550.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,136.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,107.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,975.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,835.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,575.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,783.30
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna Commercial |
$2,800.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,800.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,800.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,575.45
|
| Rate for Payer: Multiplan Commercial |
$3,255.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,975.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,575.45
|
| Rate for Payer: United Healthcare Commercial |
$3,325.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,575.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,575.45
|
|
|
Critical Care 2hrs 30 mins >
|
Facility
|
IP
|
$3,501.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929205
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$2,591.09 |
| Max. Negotiated Rate |
$3,325.95 |
| Rate for Payer: Aetna of VT Commercial |
$3,325.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,591.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,591.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,975.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,940.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,800.80
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna Commercial |
$2,800.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,800.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,800.80
|
| Rate for Payer: Multiplan Commercial |
$3,255.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,975.85
|
| Rate for Payer: United Healthcare Commercial |
$3,325.95
|
|
|
Critical Care 2hrs 30 mins >
|
Professional
|
Both
|
$3,501.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929205
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$3,290.94 |
| Rate for Payer: Aetna of VT Commercial |
$3,290.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.29
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cigna Commercial |
$108.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.95
|
| Rate for Payer: Multiplan Commercial |
$3,255.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare Commercial |
$152.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare VA CCN |
$99.42
|
|
|
CRITICAL CARE 30-74 MIN
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9879929101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$961.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$475.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$961.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$645.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$912.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$869.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$482.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$853.03
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$858.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$482.85
|
| Rate for Payer: Multiplan Commercial |
$997.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$912.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$482.85
|
| Rate for Payer: United Healthcare Commercial |
$1,019.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$482.85
|
| Rate for Payer: United Healthcare VA CCN |
$482.85
|
|
|
CRITICAL CARE 30-74 MIN
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9879929101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$794.13 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$794.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$912.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$901.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$858.40
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$858.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$858.40
|
| Rate for Payer: Multiplan Commercial |
$997.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$912.05
|
| Rate for Payer: United Healthcare Commercial |
$1,019.35
|
|
|
Critical Care 30 mins
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.47 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna of VT Commercial |
$665.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$310.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$422.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$567.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$315.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$557.29
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$560.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.45
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$595.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$315.45
|
| Rate for Payer: United Healthcare Commercial |
$665.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.45
|
| Rate for Payer: United Healthcare VA CCN |
$315.45
|
|
|
Critical Care 30 mins
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$518.81 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna of VT Commercial |
$665.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$518.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$518.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$588.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$560.80
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$560.80
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$595.85
|
| Rate for Payer: United Healthcare Commercial |
$665.95
|
|
|
Critical Care 30 mins
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9879929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$658.94 |
| Rate for Payer: Aetna of VT Commercial |
$658.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.29
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$108.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.95
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare Commercial |
$152.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.42
|
| Rate for Payer: United Healthcare VA CCN |
$99.42
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9819929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna of VT Commercial |
$438.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.60
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$369.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$369.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$369.60
|
| Rate for Payer: Multiplan Commercial |
$429.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.70
|
| Rate for Payer: United Healthcare Commercial |
$438.90
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$541.82
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
4509929201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$514.73 |
| Rate for Payer: Aetna of VT Commercial |
$514.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$485.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$239.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$485.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$243.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.75
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cigna Commercial |
$433.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$243.82
|
| Rate for Payer: Multiplan Commercial |
$503.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.82
|
| Rate for Payer: United Healthcare Commercial |
$514.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.82
|
| Rate for Payer: United Healthcare VA CCN |
$243.82
|
|
