|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9601174001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.20
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
9811174002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna of VT Commercial |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.03
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.19
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: United Healthcare VA CCN |
$31.42
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$251.99
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4109466401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$239.39 |
| Rate for Payer: Aetna of VT Commercial |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$225.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$225.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$151.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$214.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.33
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$201.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$201.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$201.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$234.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.40
|
| Rate for Payer: United Healthcare VA CCN |
$113.40
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
IP
|
$251.99
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4109466401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$186.50 |
| Max. Negotiated Rate |
$239.39 |
| Rate for Payer: Aetna of VT Commercial |
$239.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$214.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.59
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$201.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$201.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$201.59
|
| Rate for Payer: Multiplan Commercial |
$234.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.19
|
| Rate for Payer: United Healthcare Commercial |
$239.39
|
|
|
EVALUATE SPEECH PRODUCTION
|
Facility
|
OP
|
$369.64
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
4409252201
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$163.71 |
| Max. Negotiated Rate |
$351.16 |
| Rate for Payer: Aetna of VT Commercial |
$351.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.86
|
| Rate for Payer: Cash Price |
$184.82
|
| Rate for Payer: Cigna Commercial |
$295.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.34
|
| Rate for Payer: Multiplan Commercial |
$343.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.34
|
| Rate for Payer: United Healthcare Commercial |
$351.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.34
|
| Rate for Payer: United Healthcare VA CCN |
$166.34
|
|
|
EVALUATE SPEECH PRODUCTION
|
Facility
|
IP
|
$369.64
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
4409252201
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$273.57 |
| Max. Negotiated Rate |
$351.16 |
| Rate for Payer: Aetna of VT Commercial |
$351.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$273.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$273.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$295.71
|
| Rate for Payer: Cash Price |
$184.82
|
| Rate for Payer: Cigna Commercial |
$295.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.71
|
| Rate for Payer: Multiplan Commercial |
$343.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.19
|
| Rate for Payer: United Healthcare Commercial |
$351.16
|
|
|
EVALUATE SWALLOWING FUNCTION
|
Facility
|
OP
|
$448.76
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
4409261001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$198.76 |
| Max. Negotiated Rate |
$426.32 |
| Rate for Payer: Aetna of VT Commercial |
$426.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$402.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$198.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$402.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$381.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.76
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cigna Commercial |
$359.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.94
|
| Rate for Payer: Multiplan Commercial |
$417.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.94
|
| Rate for Payer: United Healthcare Commercial |
$426.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.94
|
| Rate for Payer: United Healthcare VA CCN |
$201.94
|
|
|
EVALUATE SWALLOWING FUNCTION
|
Facility
|
IP
|
$448.76
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
4409261001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$332.13 |
| Max. Negotiated Rate |
$426.32 |
| Rate for Payer: Aetna of VT Commercial |
$426.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$381.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$359.01
|
| Rate for Payer: Cash Price |
$224.38
|
| Rate for Payer: Cigna Commercial |
$359.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.01
|
| Rate for Payer: Multiplan Commercial |
$417.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.45
|
| Rate for Payer: United Healthcare Commercial |
$426.32
|
|
|
EVALUATION OF SPEECH FLUENCY
|
Facility
|
OP
|
$679.34
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
4409252101
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$300.88 |
| Max. Negotiated Rate |
$645.37 |
| Rate for Payer: Aetna of VT Commercial |
$645.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$608.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$300.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$608.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$408.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$550.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$540.08
|
| Rate for Payer: Cash Price |
$339.67
|
| Rate for Payer: Cigna Commercial |
$543.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.70
|
| Rate for Payer: Multiplan Commercial |
$631.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.70
|
| Rate for Payer: United Healthcare Commercial |
$645.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.70
|
| Rate for Payer: United Healthcare VA CCN |
$305.70
|
|
|
EVALUATION OF SPEECH FLUENCY
|
Facility
|
IP
|
$679.34
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
4409252101
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$502.78 |
| Max. Negotiated Rate |
$645.37 |
| Rate for Payer: Aetna of VT Commercial |
$645.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$577.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$570.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$543.47
|
| Rate for Payer: Cash Price |
$339.67
|
| Rate for Payer: Cigna Commercial |
$543.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$543.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$543.47
|
| Rate for Payer: Multiplan Commercial |
$631.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.44
|
| Rate for Payer: United Healthcare Commercial |
$645.37
|
|
|
EVALUATION OF WHEEZING
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
9769406001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$387.28 |
| Rate for Payer: Aetna of VT Commercial |
$387.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$369.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$369.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.65
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$55.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.33
|
| Rate for Payer: Multiplan Commercial |
$383.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.32
|
| Rate for Payer: United Healthcare Commercial |
$57.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.32
|
| Rate for Payer: United Healthcare VA CCN |
$37.32
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
9769407001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare VA CCN |
$33.30
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
OP
|
$1,209.78
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
4609407001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$535.81 |
| Max. Negotiated Rate |
$1,149.29 |
| Rate for Payer: Aetna of VT Commercial |
$1,149.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,083.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$535.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,083.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$728.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,028.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$979.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$961.78
|
| Rate for Payer: Cash Price |
$604.89
|
| Rate for Payer: Cigna Commercial |
$967.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$967.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$967.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.40
|
| Rate for Payer: Multiplan Commercial |
$1,125.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,028.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.40
|
| Rate for Payer: United Healthcare Commercial |
$1,149.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.40
|
| Rate for Payer: United Healthcare VA CCN |
$544.40
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
9769406001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna of VT Commercial |
$391.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$350.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$346.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.60
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$329.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$329.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$329.60
|
| Rate for Payer: Multiplan Commercial |
$383.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$350.20
|
| Rate for Payer: United Healthcare Commercial |
$391.40
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
IP
|
$631.77
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4609406001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$467.57 |
| Max. Negotiated Rate |
$600.18 |
| Rate for Payer: Aetna of VT Commercial |
$600.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$467.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$467.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$537.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$530.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$505.42
|
| Rate for Payer: Cash Price |
$315.88
|
| Rate for Payer: Cigna Commercial |
$505.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$505.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$505.42
|
| Rate for Payer: Multiplan Commercial |
$587.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$537.00
|
| Rate for Payer: United Healthcare Commercial |
$600.18
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
9769407001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.20
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
IP
|
$1,209.78
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
4609407001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$895.36 |
| Max. Negotiated Rate |
$1,149.29 |
| Rate for Payer: Aetna of VT Commercial |
$1,149.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$895.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$895.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,028.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$967.82
|
| Rate for Payer: Cash Price |
$604.89
|
| Rate for Payer: Cigna Commercial |
$967.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$967.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$967.82
|
| Rate for Payer: Multiplan Commercial |
$1,125.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,028.31
|
| Rate for Payer: United Healthcare Commercial |
$1,149.29
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
9769406001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$182.47 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna of VT Commercial |
$391.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$369.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$369.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$350.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$327.54
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cigna Commercial |
$329.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$329.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$329.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.40
|
| Rate for Payer: Multiplan Commercial |
$383.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$350.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.40
|
| Rate for Payer: United Healthcare Commercial |
$391.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.40
|
| Rate for Payer: United Healthcare VA CCN |
$185.40
|
|
|
EVALUATION OF WHEEZING
|
Facility
|
OP
|
$631.77
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4609406001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$279.81 |
| Max. Negotiated Rate |
$600.18 |
| Rate for Payer: Aetna of VT Commercial |
$600.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$566.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$566.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$380.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$537.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$511.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$284.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$502.26
|
| Rate for Payer: Cash Price |
$315.88
|
| Rate for Payer: Cigna Commercial |
$505.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$505.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$505.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$284.30
|
| Rate for Payer: Multiplan Commercial |
$587.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$537.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$284.30
|
| Rate for Payer: United Healthcare Commercial |
$600.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.30
|
| Rate for Payer: United Healthcare VA CCN |
$284.30
|
|
|
EVALUATION OF WHEEZING
|
Professional
|
Both
|
$1,209.78
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
4609407001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.55 |
| Max. Negotiated Rate |
$1,137.19 |
| Rate for Payer: Aetna of VT Commercial |
$1,137.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,083.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,083.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.50
|
| Rate for Payer: Cash Price |
$604.89
|
| Rate for Payer: Cash Price |
$604.89
|
| Rate for Payer: Cigna Commercial |
$90.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.55
|
| Rate for Payer: Multiplan Commercial |
$1,125.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$93.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.55
|
| Rate for Payer: United Healthcare VA CCN |
$60.55
|
|
|
EVALUATION OF WHEEZING
|
Professional
|
Both
|
$631.77
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4609406001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$593.86 |
| Rate for Payer: Aetna of VT Commercial |
$593.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$566.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$566.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.65
|
| Rate for Payer: Cash Price |
$315.88
|
| Rate for Payer: Cash Price |
$315.88
|
| Rate for Payer: Cigna Commercial |
$55.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.33
|
| Rate for Payer: Multiplan Commercial |
$587.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.32
|
| Rate for Payer: United Healthcare Commercial |
$57.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.32
|
| Rate for Payer: United Healthcare VA CCN |
$37.32
|
|
|
EVALUATION OF WHEEZING
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
9769407001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$60.55 |
| Max. Negotiated Rate |
$97.72 |
| Rate for Payer: Aetna of VT Commercial |
$69.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.50
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$90.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.55
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$93.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.55
|
| Rate for Payer: United Healthcare VA CCN |
$60.55
|
|
|
EVOKED AUDITORY TEST QUAL
|
Facility
|
OP
|
$90.99
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
4709255801
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna of VT Commercial |
$86.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.34
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.95
|
| Rate for Payer: Multiplan Commercial |
$84.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare Commercial |
$86.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare VA CCN |
$40.95
|
|
|
EVOKED AUDITORY TEST QUAL
|
Facility
|
IP
|
$90.99
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
4719255801
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna of VT Commercial |
$86.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.79
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.79
|
| Rate for Payer: Multiplan Commercial |
$84.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.34
|
| Rate for Payer: United Healthcare Commercial |
$86.44
|
|
|
EVOKED AUDITORY TEST QUAL
|
Facility
|
IP
|
$90.99
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
4709255801
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna of VT Commercial |
$86.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.79
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.79
|
| Rate for Payer: Multiplan Commercial |
$84.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.34
|
| Rate for Payer: United Healthcare Commercial |
$86.44
|
|
