|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 29898
|
| Hospital Charge Code |
9822989801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$278.14 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Aetna of VT Commercial |
$596.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$562.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$533.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$508.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$499.26
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cigna Commercial |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.60
|
| Rate for Payer: Multiplan Commercial |
$584.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$533.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.60
|
| Rate for Payer: United Healthcare Commercial |
$596.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.60
|
| Rate for Payer: United Healthcare VA CCN |
$282.60
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,039.00
|
|
|
Service Code
|
CPT 29895
|
| Hospital Charge Code |
9822989501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$903.07 |
| Max. Negotiated Rate |
$1,937.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,937.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,826.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$903.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,826.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,227.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,733.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,651.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$917.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,621.01
|
| Rate for Payer: Cash Price |
$1,019.50
|
| Rate for Payer: Cigna Commercial |
$1,631.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,631.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,631.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$917.55
|
| Rate for Payer: Multiplan Commercial |
$1,896.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,733.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$917.55
|
| Rate for Payer: United Healthcare Commercial |
$1,937.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$917.55
|
| Rate for Payer: United Healthcare VA CCN |
$917.55
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 29891
|
| Hospital Charge Code |
9822989101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,850.25 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of VT Commercial |
$2,375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,850.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,850.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,125.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,000.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,000.00
|
| Rate for Payer: Multiplan Commercial |
$2,325.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,125.00
|
| Rate for Payer: United Healthcare Commercial |
$2,375.00
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$217.14 |
| Rate for Payer: Aetna of VT Commercial |
$217.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.71
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$71.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.07
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare VA CCN |
$39.05
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Aetna of VT Commercial |
$329.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.87
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.15
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.15
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.15
|
| Rate for Payer: United Healthcare VA CCN |
$156.15
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$326.18 |
| Rate for Payer: Aetna of VT Commercial |
$326.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.71
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$71.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.07
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare VA CCN |
$39.05
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna of VT Commercial |
$219.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.80
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.35
|
| Rate for Payer: United Healthcare Commercial |
$219.45
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
5104660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna of VT Commercial |
$110.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.80
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$110.20
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna of VT Commercial |
$219.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.65
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.95
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$219.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare VA CCN |
$103.95
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9604660001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$256.81 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Aetna of VT Commercial |
$329.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.60
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.95
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
5104660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of VT Commercial |
$109.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.71
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$71.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.07
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare VA CCN |
$39.05
|
|
|
ANOSCOPY DX W/COLLJ SPEC SPX
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
5104660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna of VT Commercial |
$110.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.22
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$110.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.20
|
| Rate for Payer: United Healthcare VA CCN |
$52.20
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
5105942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$422.08 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna of VT Commercial |
$905.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$422.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$573.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$771.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$757.63
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$428.85
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.85
|
| Rate for Payer: United Healthcare VA CCN |
$428.85
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$356.73 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna of VT Commercial |
$457.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$404.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.60
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.60
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.70
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,062.04 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,363.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,062.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,062.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,219.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,205.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,148.00
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,148.00
|
| Rate for Payer: Multiplan Commercial |
$1,334.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,219.75
|
| Rate for Payer: United Healthcare Commercial |
$1,363.25
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$453.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.39
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$424.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare Commercial |
$595.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare VA CCN |
$387.40
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,348.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,285.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,285.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.39
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$424.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$1,334.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare Commercial |
$595.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare VA CCN |
$387.40
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.48 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna of VT Commercial |
$457.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$431.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$216.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.19
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.90
|
| Rate for Payer: Multiplan Commercial |
$448.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$216.90
|
| Rate for Payer: United Healthcare Commercial |
$457.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$216.90
|
| Rate for Payer: United Healthcare VA CCN |
$216.90
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9605942501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$635.56 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,363.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,285.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$635.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,285.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$863.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,219.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$645.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,140.83
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,148.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,148.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$645.75
|
| Rate for Payer: Multiplan Commercial |
$1,334.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,219.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$645.75
|
| Rate for Payer: United Healthcare Commercial |
$1,363.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$645.75
|
| Rate for Payer: United Healthcare VA CCN |
$645.75
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
5105942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$705.32 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna of VT Commercial |
$905.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$810.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$800.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$762.40
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$762.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$762.40
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.05
|
| Rate for Payer: United Healthcare Commercial |
$905.35
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISIT
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
5105942501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$895.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$853.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.39
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cash Price |
$476.50
|
| Rate for Payer: Cigna Commercial |
$424.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$886.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare Commercial |
$595.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare VA CCN |
$387.40
|
|
|
ANTEPARTUM CARE ONLY 4-6 VSTS
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9695942501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$962.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$445.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$655.39
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$424.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$872.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$872.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$952.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare Commercial |
$595.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$387.40
|
| Rate for Payer: United Healthcare VA CCN |
$387.40
|
|
|
ANTEPARTUM CARE ONLY 4-6 VSTS
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9695942501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$757.86 |
| Max. Negotiated Rate |
$972.80 |
| Rate for Payer: Aetna of VT Commercial |
$972.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$757.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$757.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$870.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$819.20
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.20
|
| Rate for Payer: Multiplan Commercial |
$952.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.40
|
| Rate for Payer: United Healthcare Commercial |
$972.80
|
|
|
ANTEPARTUM CARE ONLY 4-6 VSTS
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
9695942501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$453.53 |
| Max. Negotiated Rate |
$972.80 |
| Rate for Payer: Aetna of VT Commercial |
$972.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$453.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$917.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$616.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$870.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$829.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$460.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$814.08
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$460.80
|
| Rate for Payer: Multiplan Commercial |
$952.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$870.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$460.80
|
| Rate for Payer: United Healthcare Commercial |
$972.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.80
|
| Rate for Payer: United Healthcare VA CCN |
$460.80
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$710.23 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,668.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$731.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,590.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$994.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,197.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$816.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,197.98
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$778.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,596.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,596.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$939.57
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$710.23
|
| Rate for Payer: United Healthcare Commercial |
$1,092.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$710.23
|
| Rate for Payer: United Healthcare VA CCN |
$710.23
|
|
