|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
OP
|
$626.60
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.52 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$561.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$561.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$377.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$281.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.15
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$281.97
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare VA CCN |
$281.97
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
IP
|
$626.60
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.28
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
|
|
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
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9829928301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$454.42 |
| Max. Negotiated Rate |
$974.70 |
| Rate for Payer: Aetna of VT Commercial |
$974.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$454.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$919.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$617.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$872.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$831.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$815.67
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$820.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$820.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$461.70
|
| Rate for Payer: Multiplan Commercial |
$954.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$872.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare Commercial |
$974.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.70
|
| Rate for Payer: United Healthcare VA CCN |
$461.70
|
|
|
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
|
Professional
|
Both
|
$1,026.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9829928301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$65.68 |
| Max. Negotiated Rate |
$964.44 |
| Rate for Payer: Aetna of VT Commercial |
$964.44
|
| 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 |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| 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 |
$954.18
|
| 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
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
9819928301
|
|
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
|
|
|
EMERGENCY DEPT VISIT LOW MDM
|
Facility
|
IP
|
$975.58
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.03 |
| 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 |
$722.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$722.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$819.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$780.46
|
| 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: Multiplan Commercial |
$907.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.24
|
| Rate for Payer: United Healthcare Commercial |
$926.80
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.55
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$121.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare Commercial |
$171.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare VA CCN |
$111.80
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Professional
|
Both
|
$2,229.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9829928401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$2,095.26 |
| Rate for Payer: Aetna of VT Commercial |
$2,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.55
|
| Rate for Payer: Cash Price |
$1,114.50
|
| Rate for Payer: Cash Price |
$1,114.50
|
| Rate for Payer: Cigna Commercial |
$121.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$2,072.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare Commercial |
$171.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare VA CCN |
$111.80
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9819928402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.55
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$121.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare Commercial |
$171.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.80
|
| Rate for Payer: United Healthcare VA CCN |
$111.80
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9829928401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,649.68 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,117.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,649.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,649.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,894.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,872.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,783.20
|
| Rate for Payer: Cash Price |
$1,114.50
|
| Rate for Payer: Cigna Commercial |
$1,783.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,783.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,783.20
|
| Rate for Payer: Multiplan Commercial |
$2,072.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,894.65
|
| Rate for Payer: United Healthcare Commercial |
$2,117.55
|
|
|
EMERGENCY DEPT VISIT MOD MDM
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
9829928401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$987.22 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,117.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,996.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$987.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,996.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,341.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,894.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,805.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,003.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.06
|
| Rate for Payer: Cash Price |
$1,114.50
|
| Rate for Payer: Cigna Commercial |
$1,783.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,783.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,783.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,003.05
|
| Rate for Payer: Multiplan Commercial |
$2,072.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,894.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,003.05
|
| Rate for Payer: United Healthcare Commercial |
$2,117.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,003.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,003.05
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
9819928201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna of VT Commercial |
$182.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$153.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$178.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.20
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
9829928201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.82 |
| Max. Negotiated Rate |
$642.02 |
| Rate for Payer: Aetna of VT Commercial |
$642.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.61
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$41.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.82
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.82
|
| Rate for Payer: United Healthcare Commercial |
$59.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.82
|
| Rate for Payer: United Healthcare VA CCN |
$38.82
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Facility
|
OP
|
$326.74
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.71 |
| Max. Negotiated Rate |
$310.40 |
| Rate for Payer: Aetna of VT Commercial |
$310.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$292.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$292.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.76
|
| Rate for Payer: Cash Price |
$163.37
|
| Rate for Payer: Cigna Commercial |
$261.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.03
|
| Rate for Payer: Multiplan Commercial |
$303.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$277.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.03
|
| Rate for Payer: United Healthcare Commercial |
$310.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.03
|
| Rate for Payer: United Healthcare VA CCN |
$147.03
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
9819928201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna of VT Commercial |
$182.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.64
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$153.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$178.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.40
|
| Rate for Payer: United Healthcare Commercial |
$182.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.40
|
| Rate for Payer: United Healthcare VA CCN |
$86.40
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
9829928201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Aetna of VT Commercial |
$648.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$553.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.99
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$307.35
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare VA CCN |
$307.35
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
9819928201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.82 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna of VT Commercial |
$180.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.61
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$41.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.82
|
| Rate for Payer: Multiplan Commercial |
$178.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.82
|
| Rate for Payer: United Healthcare Commercial |
$59.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.82
|
| Rate for Payer: United Healthcare VA CCN |
$38.82
|
|
|
EMERGENCY DEPT VISIT SF MDM
|
Facility
|
IP
|
$326.74
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.82 |
| Max. Negotiated Rate |
$310.40 |
| Rate for Payer: Aetna of VT Commercial |
$310.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$274.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.39
|
| Rate for Payer: Cash Price |
$163.37
|
| Rate for Payer: Cigna Commercial |
$261.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$261.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$261.39
|
| Rate for Payer: Multiplan Commercial |
$303.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$277.73
|
| Rate for Payer: United Healthcare Commercial |
$310.40
|
|
