|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$541.82
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
4509929201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$401.00 |
| 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 |
$401.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$455.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$433.46
|
| 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: Multiplan Commercial |
$503.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$460.55
|
| Rate for Payer: United Healthcare Commercial |
$514.73
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9819929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$204.62 |
| 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 |
$413.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$413.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.29
|
| 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: Martins Point Health Care Commercial |
$207.90
|
| Rate for Payer: Multiplan Commercial |
$429.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$438.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.90
|
| Rate for Payer: United Healthcare VA CCN |
$207.90
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9819929201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$434.28 |
| Rate for Payer: Aetna of VT Commercial |
$434.28
|
| 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 |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| 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 |
$429.66
|
| 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
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9819929202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$434.28 |
| Rate for Payer: Aetna of VT Commercial |
$434.28
|
| 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 |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| 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 |
$429.66
|
| 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 |
9819929202
|
|
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
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929101
|
|
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 FIRST HOUR
|
Facility
|
OP
|
$1,713.34
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
4509929101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$758.84 |
| Max. Negotiated Rate |
$1,627.67 |
| Rate for Payer: Aetna of VT Commercial |
$1,627.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,534.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$758.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,534.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,031.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,456.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,387.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$771.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,362.11
|
| Rate for Payer: Cash Price |
$856.67
|
| Rate for Payer: Cigna Commercial |
$1,370.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,370.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,370.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$771.00
|
| Rate for Payer: Multiplan Commercial |
$1,593.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,456.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$771.00
|
| Rate for Payer: United Healthcare Commercial |
$1,627.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$771.00
|
| Rate for Payer: United Healthcare VA CCN |
$771.00
|
|
|
CRITICAL CARE FIRST HOUR
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.54 |
| Max. Negotiated Rate |
$1,008.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,008.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$409.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$409.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$277.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$450.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$450.26
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$214.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$422.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$422.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$257.96
|
| Rate for Payer: Multiplan Commercial |
$997.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.54
|
| Rate for Payer: United Healthcare Commercial |
$305.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.54
|
| Rate for Payer: United Healthcare VA CCN |
$198.54
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929101
|
|
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 FIRST HOUR
|
Facility
|
IP
|
$1,713.34
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
4509929101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,268.04 |
| Max. Negotiated Rate |
$1,627.67 |
| Rate for Payer: Aetna of VT Commercial |
$1,627.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,268.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,268.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,456.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,439.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,370.67
|
| Rate for Payer: Cash Price |
$856.67
|
| Rate for Payer: Cigna Commercial |
$1,370.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,370.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,370.67
|
| Rate for Payer: Multiplan Commercial |
$1,593.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,456.34
|
| Rate for Payer: United Healthcare Commercial |
$1,627.67
|
|
|
CRITICAL CARE FIRST HOUR
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.54 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$409.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$409.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$277.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$450.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$450.26
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$214.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$422.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$422.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$257.96
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.54
|
| Rate for Payer: United Healthcare Commercial |
$305.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.54
|
| Rate for Payer: United Healthcare VA CCN |
$198.54
|
|
|
CRITICAL CARE FIRST HOUR
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9819929102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.79
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.90
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare VA CCN |
$162.90
|
|
|
CRYOCAUTERY OF CERVIX
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.31 |
| Max. Negotiated Rate |
$494.44 |
| Rate for Payer: Aetna of VT Commercial |
$494.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.80
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$245.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.17
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare Commercial |
$212.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare VA CCN |
$138.31
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$232.97 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna of VT Commercial |
$499.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$232.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$471.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$316.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.17
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$236.70
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$236.70
|
| Rate for Payer: United Healthcare Commercial |
$499.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.70
|
| Rate for Payer: United Healthcare VA CCN |
$236.70
|
|
|
CRYOCAUTERY OF CERVIX
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.31 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna of VT Commercial |
$340.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.80
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$245.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.17
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare Commercial |
$212.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare VA CCN |
$138.31
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$267.92 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.60
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna of VT Commercial |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.60
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$34.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$389.29 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna of VT Commercial |
$499.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$447.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$441.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$420.80
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$420.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$420.80
|
| Rate for Payer: Multiplan Commercial |
$489.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$447.10
|
| Rate for Payer: United Healthcare Commercial |
$499.70
|
|
|
CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna of VT Commercial |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.41
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$34.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.65
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.65
|
| Rate for Payer: United Healthcare VA CCN |
$16.65
|
|
|
CRYOCAUTERY OF CERVIX
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
9605751102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.31 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna of VT Commercial |
$340.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.80
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$245.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.17
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare Commercial |
$212.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.31
|
| Rate for Payer: United Healthcare VA CCN |
$138.31
|
|
|
Cryoglobulin Serum
|
Facility
|
IP
|
$62.04
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3008259501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.92 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna of VT Commercial |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.63
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cigna Commercial |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.63
|
| Rate for Payer: Multiplan Commercial |
$57.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.73
|
| Rate for Payer: United Healthcare Commercial |
$58.94
|
|
|
Cryoglobulin Serum
|
Facility
|
OP
|
$62.04
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3008259501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna of VT Commercial |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.32
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cigna Commercial |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.92
|
| Rate for Payer: Multiplan Commercial |
$57.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.92
|
| Rate for Payer: United Healthcare Commercial |
$58.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare VA CCN |
$27.92
|
|
