|
ANTISTREPTOLYSIN O TITER
|
Facility
|
OP
|
$119.26
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
3008606001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$113.30 |
| Rate for Payer: Aetna of VT Commercial |
$113.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.81
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cigna Commercial |
$95.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.67
|
| Rate for Payer: Multiplan Commercial |
$110.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.67
|
| Rate for Payer: United Healthcare Commercial |
$113.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.30
|
| Rate for Payer: United Healthcare VA CCN |
$53.67
|
|
|
ANTISTREPTOLYSIN O TITER
|
Facility
|
IP
|
$119.26
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
3008606001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$113.30 |
| Rate for Payer: Aetna of VT Commercial |
$113.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.41
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cigna Commercial |
$95.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.41
|
| Rate for Payer: Multiplan Commercial |
$110.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.37
|
| Rate for Payer: United Healthcare Commercial |
$113.30
|
|
|
ANTISTREPTOLYSIN O TITER
|
Professional
|
Both
|
$119.26
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
3008606001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna of VT Commercial |
$112.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.49
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cash Price |
$59.63
|
| Rate for Payer: Cigna Commercial |
$8.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$110.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.30
|
| Rate for Payer: United Healthcare Commercial |
$11.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.30
|
| Rate for Payer: United Healthcare VA CCN |
$7.30
|
|
|
ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$177.07
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
3008530001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$168.22 |
| Rate for Payer: Aetna of VT Commercial |
$168.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.77
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cigna Commercial |
$141.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$164.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.68
|
| Rate for Payer: United Healthcare Commercial |
$168.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare VA CCN |
$79.68
|
|
|
ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$177.07
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
3008530001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.05 |
| Max. Negotiated Rate |
$168.22 |
| Rate for Payer: Aetna of VT Commercial |
$168.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.66
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cigna Commercial |
$141.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.66
|
| Rate for Payer: Multiplan Commercial |
$164.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.51
|
| Rate for Payer: United Healthcare Commercial |
$168.22
|
|
|
ANTITHROMBIN III ACTIVITY
|
Professional
|
Both
|
$177.07
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
3008530001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$166.45 |
| Rate for Payer: Aetna of VT Commercial |
$166.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.25
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cigna Commercial |
$14.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$164.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare VA CCN |
$11.85
|
|
|
APOLIPOPROTEIN EACH
|
Facility
|
OP
|
$124.83
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3008217201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$118.59 |
| Rate for Payer: Aetna of VT Commercial |
$118.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.24
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cigna Commercial |
$99.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.17
|
| Rate for Payer: Multiplan Commercial |
$116.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.17
|
| Rate for Payer: United Healthcare Commercial |
$118.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare VA CCN |
$56.17
|
|
|
APOLIPOPROTEIN EACH
|
Professional
|
Both
|
$124.83
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3008217201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$117.34 |
| Rate for Payer: Aetna of VT Commercial |
$117.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cigna Commercial |
$25.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.79
|
| Rate for Payer: Multiplan Commercial |
$116.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$32.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare VA CCN |
$21.09
|
|
|
APOLIPOPROTEIN EACH
|
Facility
|
IP
|
$124.83
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3008217201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$118.59 |
| Rate for Payer: Aetna of VT Commercial |
$118.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.86
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cigna Commercial |
$99.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.86
|
| Rate for Payer: Multiplan Commercial |
$116.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.11
|
| Rate for Payer: United Healthcare Commercial |
$118.59
|
|
|
APPENDECTOMY
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
9824495001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,338.84 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,718.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,338.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,338.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,537.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,519.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,447.20
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cigna Commercial |
$1,447.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,447.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,447.20
|
| Rate for Payer: Multiplan Commercial |
$1,682.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,537.65
|
| Rate for Payer: United Healthcare Commercial |
$1,718.55
|
|
|
APPENDECTOMY
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
9824495001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$801.21 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,718.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,620.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$801.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,620.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,089.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,537.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,465.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$814.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,438.15
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cigna Commercial |
$1,447.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,447.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,447.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$814.05
|
| Rate for Payer: Multiplan Commercial |
$1,682.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,537.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$814.05
|
| Rate for Payer: United Healthcare Commercial |
$1,718.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$814.05
|
| Rate for Payer: United Healthcare VA CCN |
$814.05
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
9824495001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$586.68 |
| Max. Negotiated Rate |
$1,700.46 |
| Rate for Payer: Aetna of VT Commercial |
$1,700.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,620.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$604.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,620.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$821.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$999.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$999.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$674.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$999.34
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cigna Commercial |
$1,073.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$998.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$998.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$586.69
|
| Rate for Payer: Multiplan Commercial |
$1,682.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$833.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$586.68
|
| Rate for Payer: United Healthcare Commercial |
$902.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$586.68
|
| Rate for Payer: United Healthcare VA CCN |
$586.68
|
|
|
APPENDECTOMY ADD-ON
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
9824495501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$75.10 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna of VT Commercial |
$262.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.15
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$137.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.10
|
| Rate for Payer: Multiplan Commercial |
$259.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.10
|
| Rate for Payer: United Healthcare Commercial |
$115.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.10
|
| Rate for Payer: United Healthcare VA CCN |
$75.10
|
|
|
APPENDECTOMY ADD-ON
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
9824495501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$206.49 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna of VT Commercial |
$265.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$223.20
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$259.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.15
|
| Rate for Payer: United Healthcare Commercial |
$265.05
|
|
|
APPENDECTOMY ADD-ON
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
9824495501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna of VT Commercial |
$265.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.81
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$223.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.55
|
| Rate for Payer: Multiplan Commercial |
$259.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.55
|
| Rate for Payer: United Healthcare Commercial |
$265.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.55
|
| Rate for Payer: United Healthcare VA CCN |
$125.55
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
OP
|
$201.73
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
4502950501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$191.64 |
| Rate for Payer: Aetna of VT Commercial |
$191.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.38
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cigna Commercial |
$161.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.78
|
| Rate for Payer: Multiplan Commercial |
$187.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.78
|
| Rate for Payer: United Healthcare Commercial |
$191.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.78
|
| Rate for Payer: United Healthcare VA CCN |
$90.78
|
|
|
APPLICATION LONG LEG SPLINT
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$276.36 |
| Rate for Payer: Aetna of VT Commercial |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.90
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$93.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.06
|
| Rate for Payer: Multiplan Commercial |
$273.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.87
|
| Rate for Payer: United Healthcare Commercial |
$76.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.87
|
| Rate for Payer: United Healthcare VA CCN |
$49.87
|
|
|
APPLICATION LONG LEG SPLINT
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$213.38 |
| Rate for Payer: Aetna of VT Commercial |
$213.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.90
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$93.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.06
|
| Rate for Payer: Multiplan Commercial |
$211.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.87
|
| Rate for Payer: United Healthcare Commercial |
$76.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.87
|
| Rate for Payer: United Healthcare VA CCN |
$49.87
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna of VT Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$263.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$176.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.73
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$273.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.30
|
| Rate for Payer: United Healthcare Commercial |
$279.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.30
|
| Rate for Payer: United Healthcare VA CCN |
$132.30
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$217.59 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna of VT Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.20
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$273.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$279.30
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
IP
|
$201.73
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
4502950501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.30 |
| Max. Negotiated Rate |
$191.64 |
| Rate for Payer: Aetna of VT Commercial |
$191.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.38
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cigna Commercial |
$161.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.38
|
| Rate for Payer: Multiplan Commercial |
$187.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.47
|
| Rate for Payer: United Healthcare Commercial |
$191.64
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna of VT Commercial |
$215.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.60
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$211.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.95
|
| Rate for Payer: United Healthcare Commercial |
$215.65
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
9812950501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna of VT Commercial |
$215.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.47
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.15
|
| Rate for Payer: Multiplan Commercial |
$211.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.15
|
| Rate for Payer: United Healthcare Commercial |
$215.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.15
|
| Rate for Payer: United Healthcare VA CCN |
$102.15
|
|
|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9822951501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.53
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$89.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.91
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare Commercial |
$72.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare VA CCN |
$47.14
|
|
|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
9812951502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.53
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$89.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.91
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare Commercial |
$72.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.14
|
| Rate for Payer: United Healthcare VA CCN |
$47.14
|
|
