|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9825174101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.80
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9825174101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$179.54 |
| Rate for Payer: Aetna of VT Commercial |
$179.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.84
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$23.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$20.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare VA CCN |
$13.39
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9605174101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.80
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9605174102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.84
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.95
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare VA CCN |
$85.95
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna of VT Commercial |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.84
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$23.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$117.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$20.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare VA CCN |
$13.39
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of VT Commercial |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.17
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.70
|
| Rate for Payer: Multiplan Commercial |
$117.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.70
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.70
|
| Rate for Payer: United Healthcare VA CCN |
$56.70
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9605174101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.22
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare VA CCN |
$142.20
|
|
|
ELIGARD 22.5 MG
|
Facility
|
OP
|
$359.48
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
636J921702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.21 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna of VT Commercial |
$341.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.79
|
| Rate for Payer: Cash Price |
$179.74
|
| Rate for Payer: Cash Price |
$179.74
|
| Rate for Payer: Cigna Commercial |
$287.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.77
|
| Rate for Payer: Multiplan Commercial |
$334.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.77
|
| Rate for Payer: United Healthcare Commercial |
$341.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.77
|
| Rate for Payer: United Healthcare VA CCN |
$161.77
|
|
|
ELIGARD 22.5 MG
|
Professional
|
Both
|
$359.48
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
636J921702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna of VT Commercial |
$337.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.92
|
| Rate for Payer: Cash Price |
$179.74
|
| Rate for Payer: Cash Price |
$179.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.29
|
| Rate for Payer: Multiplan Commercial |
$334.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.45
|
| Rate for Payer: United Healthcare Commercial |
$271.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.45
|
| Rate for Payer: United Healthcare VA CCN |
$176.45
|
|
|
ELIGARD 22.5 MG
|
Facility
|
IP
|
$359.48
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
636J921702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$341.51 |
| Rate for Payer: Aetna of VT Commercial |
$341.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.58
|
| Rate for Payer: Cash Price |
$179.74
|
| Rate for Payer: Cigna Commercial |
$287.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.58
|
| Rate for Payer: Multiplan Commercial |
$334.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.56
|
| Rate for Payer: United Healthcare Commercial |
$341.51
|
|
|
EMA EACH IG CLASS
|
Facility
|
OP
|
$221.02
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
3008623101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$209.97 |
| Rate for Payer: Aetna of VT Commercial |
$209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.71
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.46
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.46
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare VA CCN |
$99.46
|
|
|
EMA EACH IG CLASS
|
Facility
|
IP
|
$221.02
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
3008623101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$209.97 |
| Rate for Payer: Aetna of VT Commercial |
$209.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.82
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.82
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.87
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
|
|
EMA EACH IG CLASS
|
Professional
|
Both
|
$221.02
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
3008623101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna of VT Commercial |
$207.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.24
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cash Price |
$110.51
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.92
|
| Rate for Payer: Multiplan Commercial |
$205.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare Commercial |
$18.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare VA CCN |
$12.09
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
OP
|
$1,292.24
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$572.33 |
| Max. Negotiated Rate |
$1,227.63 |
| Rate for Payer: Aetna of VT Commercial |
$1,227.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,157.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$572.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,157.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$777.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,046.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$581.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,027.33
|
| Rate for Payer: Cash Price |
$646.12
|
| Rate for Payer: Cigna Commercial |
$1,033.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,033.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,033.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$581.51
|
| Rate for Payer: Multiplan Commercial |
$1,201.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$581.51
|
| Rate for Payer: United Healthcare Commercial |
$1,227.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.51
|
| Rate for Payer: United Healthcare VA CCN |
$581.51
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
IP
|
$1,292.24
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$956.39 |
| Max. Negotiated Rate |
$1,227.63 |
| Rate for Payer: Aetna of VT Commercial |
$1,227.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$956.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$956.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,085.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,033.79
|
| Rate for Payer: Cash Price |
$646.12
|
| Rate for Payer: Cigna Commercial |
$1,033.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,033.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,033.79
|
| Rate for Payer: Multiplan Commercial |
$1,201.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,098.40
|
| Rate for Payer: United Healthcare Commercial |
$1,227.63
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$522.51 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$564.80
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$663.64 |
| Rate for Payer: Aetna of VT Commercial |
$663.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.82
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$175.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.97
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.97
|
| Rate for Payer: United Healthcare Commercial |
$249.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.97
|
| Rate for Payer: United Healthcare VA CCN |
$161.97
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$312.69 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$312.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$317.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.27
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.70
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare VA CCN |
$317.70
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$522.51 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$522.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$593.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$564.80
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$312.69 |
| Max. Negotiated Rate |
$670.70 |
| Rate for Payer: Aetna of VT Commercial |
$670.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$312.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$571.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$317.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.27
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$317.70
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare Commercial |
$670.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.70
|
| Rate for Payer: United Healthcare VA CCN |
$317.70
|
|
|
EMERGENCY DEPT VISIT HI MDM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
9819928502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$663.64 |
| Rate for Payer: Aetna of VT Commercial |
$663.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.82
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$175.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.97
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.97
|
| Rate for Payer: United Healthcare Commercial |
$249.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.97
|
| Rate for Payer: United Healthcare VA CCN |
$161.97
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
OP
|
$975.58
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.08 |
| Max. Negotiated Rate |
$926.80 |
| Rate for Payer: Aetna of VT Commercial |
$926.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$432.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$587.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$790.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$439.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.59
|
| Rate for Payer: Cash Price |
$487.79
|
| Rate for Payer: Cigna Commercial |
$780.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.01
|
| Rate for Payer: Multiplan Commercial |
$907.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$439.01
|
| Rate for Payer: United Healthcare Commercial |
$926.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.01
|
| Rate for Payer: United Healthcare VA CCN |
$439.01
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9819928301
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$212.41 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna of VT Commercial |
$272.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.60
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.95
|
| Rate for Payer: United Healthcare Commercial |
$272.65
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9819928302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.68 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna of VT Commercial |
$269.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.53
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$71.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.68
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.68
|
| Rate for Payer: United Healthcare Commercial |
$101.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.68
|
| Rate for Payer: United Healthcare VA CCN |
$65.68
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9819928302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$212.41 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna of VT Commercial |
$272.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.60
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.95
|
| Rate for Payer: United Healthcare Commercial |
$272.65
|
|
