|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,313.68 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,686.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,313.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,313.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,508.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,491.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,420.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,420.00
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,508.75
|
| Rate for Payer: United Healthcare Commercial |
$1,686.25
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$786.15 |
| Max. Negotiated Rate |
$1,686.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,686.25
|
| 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 |
$786.15
|
| 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 |
$1,068.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,508.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$798.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,411.12
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,420.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,420.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$798.75
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,508.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$798.75
|
| Rate for Payer: United Healthcare Commercial |
$1,686.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$798.75
|
| Rate for Payer: United Healthcare VA CCN |
$798.75
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
IP
|
$9,595.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9695942601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$7,101.26 |
| Max. Negotiated Rate |
$9,115.25 |
| Rate for Payer: Aetna of VT Commercial |
$9,115.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,101.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,101.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,155.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,676.00
|
| Rate for Payer: Cash Price |
$4,797.50
|
| Rate for Payer: Cigna Commercial |
$7,676.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,676.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,676.00
|
| Rate for Payer: Multiplan Commercial |
$8,923.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,155.75
|
| Rate for Payer: United Healthcare Commercial |
$9,115.25
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
5105942601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$831.77 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,784.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,682.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$831.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,682.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,130.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,596.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,521.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$845.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,493.01
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,502.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$845.10
|
| Rate for Payer: Multiplan Commercial |
$1,746.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,596.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$845.10
|
| Rate for Payer: United Healthcare Commercial |
$1,784.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.10
|
| Rate for Payer: United Healthcare VA CCN |
$845.10
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,703.59 |
| Max. Negotiated Rate |
$3,470.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,703.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,703.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,105.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,068.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,922.40
|
| Rate for Payer: Cash Price |
$1,826.50
|
| Rate for Payer: Cigna Commercial |
$2,922.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,922.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,922.40
|
| Rate for Payer: Multiplan Commercial |
$3,397.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,105.05
|
| Rate for Payer: United Healthcare Commercial |
$3,470.35
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Professional
|
Both
|
$1,878.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
5105942601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$710.23 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,765.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,682.50
|
| 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 |
$1,682.50
|
| 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 |
$939.00
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cash Price |
$939.00
|
| 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 |
$1,746.54
|
| 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
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
5105942601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,389.91 |
| Max. Negotiated Rate |
$1,784.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,784.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,389.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,389.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,596.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,577.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,502.40
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,502.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,502.40
|
| Rate for Payer: Multiplan Commercial |
$1,746.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,596.30
|
| Rate for Payer: United Healthcare Commercial |
$1,784.10
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,617.91 |
| Max. Negotiated Rate |
$3,470.35 |
| Rate for Payer: Aetna of VT Commercial |
$3,470.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,272.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,617.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,272.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,199.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,105.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,958.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,643.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,904.14
|
| Rate for Payer: Cash Price |
$1,826.50
|
| Rate for Payer: Cigna Commercial |
$2,922.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,922.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,922.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,643.85
|
| Rate for Payer: Multiplan Commercial |
$3,397.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,105.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,643.85
|
| Rate for Payer: United Healthcare Commercial |
$3,470.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,643.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,643.85
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Professional
|
Both
|
$3,653.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9605942601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$710.23 |
| Max. Negotiated Rate |
$3,433.82 |
| Rate for Payer: Aetna of VT Commercial |
$3,433.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,272.72
|
| 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 |
$3,272.72
|
| 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 |
$1,826.50
|
| Rate for Payer: Cash Price |
$1,826.50
|
| Rate for Payer: Cash Price |
$1,826.50
|
| 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 |
$3,397.29
|
| 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
|
|
|
ANTEPARTUM CARE ONLY 7/> VSTS
|
Facility
|
OP
|
$9,595.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
9695942601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$4,249.63 |
| Max. Negotiated Rate |
$9,115.25 |
| Rate for Payer: Aetna of VT Commercial |
$9,115.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,596.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,249.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,596.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,776.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8,155.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,771.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,317.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,628.02
|
| Rate for Payer: Cash Price |
$4,797.50
|
| Rate for Payer: Cigna Commercial |
$7,676.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,676.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,676.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,317.75
|
| Rate for Payer: Multiplan Commercial |
$8,923.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,155.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,317.75
|
| Rate for Payer: United Healthcare Commercial |
$9,115.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,317.75
|
| Rate for Payer: United Healthcare VA CCN |
$4,317.75
|
|
|
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
|
|
|
ANTEPARTUM MANIPULATION
|
Facility
|
OP
|
$523.20
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
7205941201
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$231.73 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$468.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$468.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.94
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare VA CCN |
$235.44
|
|
|
ANTEPARTUM MANIPULATION
|
Facility
|
IP
|
$523.20
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
7205941201
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$387.22 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.56
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
|
|
ANTEPARTUM MANIPULATION 52 MOD
|
Facility
|
OP
|
$523.20
|
|
|
Service Code
|
CPT 59412 52
|
| Hospital Charge Code |
7205941202
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$231.73 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$468.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$468.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.94
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare VA CCN |
$235.44
|
|
|
ANTEPARTUM MANIPULATION 52 MOD
|
Facility
|
IP
|
$523.20
|
|
|
Service Code
|
CPT 59412 52
|
| Hospital Charge Code |
7205941202
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$387.22 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.56
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
|
|
ANTERIOR COLPORRHAPHY
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
9825724001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$631.13 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,353.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,276.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$631.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,276.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$857.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,154.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$641.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,132.88
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,140.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$641.25
|
| Rate for Payer: Multiplan Commercial |
$1,325.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,211.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$641.25
|
| Rate for Payer: United Healthcare Commercial |
$1,353.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$641.25
|
| Rate for Payer: United Healthcare VA CCN |
$641.25
|
|
|
ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
9825724001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$572.53 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,339.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,276.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$589.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,276.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$801.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$805.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$805.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$658.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$805.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,010.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$951.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$951.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$572.53
|
| Rate for Payer: Multiplan Commercial |
$1,325.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$812.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$572.53
|
| Rate for Payer: United Healthcare Commercial |
$880.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$572.53
|
| Rate for Payer: United Healthcare VA CCN |
$572.53
|
|
|
ANTERIOR COLPORRHAPHY
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
9825724001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,054.64 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,353.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,054.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,054.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,211.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,140.00
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,140.00
|
| Rate for Payer: Multiplan Commercial |
$1,325.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,211.25
|
| Rate for Payer: United Healthcare Commercial |
$1,353.75
|
|
|
ANTIBODY CYTOMEGALOVIRUS CMV
|
Professional
|
Both
|
$132.64
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
3008664401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Aetna of VT Commercial |
$124.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.61
|
| Rate for Payer: Cash Price |
$66.32
|
| Rate for Payer: Cash Price |
$66.32
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$123.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
ANTIBODY CYTOMEGALOVIRUS CMV
|
Facility
|
OP
|
$132.64
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
3008664401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$126.01 |
| Rate for Payer: Aetna of VT Commercial |
$126.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.45
|
| Rate for Payer: Cash Price |
$66.32
|
| Rate for Payer: Cash Price |
$66.32
|
| Rate for Payer: Cigna Commercial |
$106.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.69
|
| Rate for Payer: Multiplan Commercial |
$123.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.69
|
| Rate for Payer: United Healthcare Commercial |
$126.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$59.69
|
|
|
ANTIBODY CYTOMEGALOVIRUS CMV
|
Facility
|
IP
|
$132.64
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
3008664401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.17 |
| Max. Negotiated Rate |
$126.01 |
| Rate for Payer: Aetna of VT Commercial |
$126.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.11
|
| Rate for Payer: Cash Price |
$66.32
|
| Rate for Payer: Cigna Commercial |
$106.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.11
|
| Rate for Payer: Multiplan Commercial |
$123.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.74
|
| Rate for Payer: United Healthcare Commercial |
$126.01
|
|
|
ANTIBODY EHRLICHIA
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
3008666601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.84
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare VA CCN |
$68.40
|
|
|
ANTIBODY EHRLICHIA
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
3008666601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$142.88 |
| Rate for Payer: Aetna of VT Commercial |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$12.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare VA CCN |
$10.18
|
|
|
ANTIBODY EHRLICHIA
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
3008666601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.60
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
|
|
ANTIBODY HERPES SMPLX TYPE 1
|
Professional
|
Both
|
$150.96
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3008669501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$141.90 |
| Rate for Payer: Aetna of VT Commercial |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.55
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$140.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$20.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$13.19
|
|
