|
HOME/RES VST NEW LOW MDM 30
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
9839934201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
HOME/RES VST NEW LOW MDM 30
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
9839934201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$150.25 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.25
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$80.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.46
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.46
|
| Rate for Payer: United Healthcare Commercial |
$114.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.46
|
| Rate for Payer: United Healthcare VA CCN |
$74.46
|
|
|
HOSPITAL DISCH DAY MGMT 30/<
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
9879923801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna of VT Commercial |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.80
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.35
|
| Rate for Payer: United Healthcare Commercial |
$162.45
|
|
|
HOSPITAL DISCH DAY MGMT 30/<
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
9879923801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna of VT Commercial |
$160.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.06
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$82.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.23
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.23
|
| Rate for Payer: United Healthcare Commercial |
$117.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.23
|
| Rate for Payer: United Healthcare VA CCN |
$76.23
|
|
|
HOSPITAL DISCH DAY MGMT 30/<
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
9879923801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna of VT Commercial |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.94
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.95
|
| Rate for Payer: Multiplan Commercial |
$159.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.95
|
| Rate for Payer: United Healthcare Commercial |
$162.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.95
|
| Rate for Payer: United Healthcare VA CCN |
$76.95
|
|
|
HOSPITAL DISCH DAY MGMT 30/>
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
9879923901
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$297.04 |
| Rate for Payer: Aetna of VT Commercial |
$297.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.91
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.88
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.88
|
| Rate for Payer: United Healthcare Commercial |
$165.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.88
|
| Rate for Payer: United Healthcare VA CCN |
$107.88
|
|
|
HOSPITAL DISCH DAY MGMT 30/>
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
9879923901
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.80
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
HOSPITAL DISCH DAY MGMT 30/>
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
9879923901
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.22
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare VA CCN |
$142.20
|
|
|
HOSPITAL OBS, DIRECT ADMISSION
|
Facility
|
IP
|
$770.33
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7620037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna of VT Commercial |
$731.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$570.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$570.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$647.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$616.26
|
| Rate for Payer: Cash Price |
$385.16
|
| Rate for Payer: Cigna Commercial |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$616.26
|
| Rate for Payer: Multiplan Commercial |
$716.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$654.78
|
| Rate for Payer: United Healthcare Commercial |
$731.81
|
|
|
HOSPITAL OBS, DIRECT ADMISSION
|
Facility
|
OP
|
$770.33
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7620037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$341.18 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna of VT Commercial |
$731.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$690.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$690.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$463.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$346.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.41
|
| Rate for Payer: Cash Price |
$385.16
|
| Rate for Payer: Cigna Commercial |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$616.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.65
|
| Rate for Payer: Multiplan Commercial |
$716.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.65
|
| Rate for Payer: United Healthcare Commercial |
$731.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.65
|
| Rate for Payer: United Healthcare VA CCN |
$346.65
|
|
|
HOSPITAL OBS SERV, PER HOUR ER
|
Facility
|
OP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7620037802
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.09
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare VA CCN |
$44.20
|
|
|
HOSPITAL OBS SERV, PER HOUR ER
|
Facility
|
IP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7620037802
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.58
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.50
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
|
|
HOSPITAL OBS SERV, PER HOUR MS
|
Facility
|
IP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7620037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.58
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.50
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
|
|
HOSPITAL OBS SERV, PER HOUR MS
|
Facility
|
OP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7620037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.09
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare VA CCN |
$44.20
|
|
|
HOSPITAL OBS SERV, PER HOUR OB
|
Facility
|
OP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7200037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.09
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.20
|
| Rate for Payer: United Healthcare VA CCN |
$44.20
|
|
|
HOSPITAL OBS SERV, PER HOUR OB
|
Facility
|
IP
|
$98.23
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
7200037801
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Aetna of VT Commercial |
$93.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.58
|
| Rate for Payer: Cash Price |
$49.12
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.58
|
| Rate for Payer: Multiplan Commercial |
$91.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.50
|
| Rate for Payer: United Healthcare Commercial |
$93.32
|
|
|
HOSP OBS, DIRECT ADMISSION OB
|
Facility
|
OP
|
$770.33
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7620037902
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$341.18 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna of VT Commercial |
$731.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$690.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$690.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$463.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$346.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.41
|
| Rate for Payer: Cash Price |
$385.16
|
| Rate for Payer: Cigna Commercial |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$616.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.65
|
| Rate for Payer: Multiplan Commercial |
$716.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$346.65
|
| Rate for Payer: United Healthcare Commercial |
$731.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.65
|
| Rate for Payer: United Healthcare VA CCN |
$346.65
|
|
|
HOSP OBS, DIRECT ADMISSION OB
|
Facility
|
IP
|
$770.33
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
7620037902
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$731.81 |
| Rate for Payer: Aetna of VT Commercial |
$731.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$570.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$570.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$654.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$647.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$616.26
|
| Rate for Payer: Cash Price |
$385.16
|
| Rate for Payer: Cigna Commercial |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$616.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$616.26
|
| Rate for Payer: Multiplan Commercial |
$716.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$654.78
|
| Rate for Payer: United Healthcare Commercial |
$731.81
|
|
|
HOT OR COLD PACKS THERAPY
|
Facility
|
OP
|
$21.71
|
|
|
Service Code
|
CPT 97010 GP
|
| Hospital Charge Code |
4209701001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna of VT Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.26
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cigna Commercial |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.77
|
| Rate for Payer: Multiplan Commercial |
$20.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare VA CCN |
$9.77
|
|
|
HOT OR COLD PACKS THERAPY
|
Facility
|
OP
|
$21.71
|
|
|
Service Code
|
CPT 97010 GO
|
| Hospital Charge Code |
4309701001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna of VT Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.26
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cigna Commercial |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.77
|
| Rate for Payer: Multiplan Commercial |
$20.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare VA CCN |
$9.77
|
|
|
HOT OR COLD PACKS THERAPY
|
Facility
|
IP
|
$21.71
|
|
|
Service Code
|
CPT 97010 GO
|
| Hospital Charge Code |
4309701001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna of VT Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.37
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cigna Commercial |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.37
|
| Rate for Payer: Multiplan Commercial |
$20.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.45
|
| Rate for Payer: United Healthcare Commercial |
$20.62
|
|
|
HOT OR COLD PACKS THERAPY
|
Facility
|
IP
|
$21.71
|
|
|
Service Code
|
CPT 97010 GP
|
| Hospital Charge Code |
4209701001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna of VT Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.37
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cigna Commercial |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.37
|
| Rate for Payer: Multiplan Commercial |
$20.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.45
|
| Rate for Payer: United Healthcare Commercial |
$20.62
|
|
|
HPV HIGH-RISK TYPES
|
Professional
|
Both
|
$177.85
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3008762401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.59
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
HPV HIGH-RISK TYPES
|
Facility
|
IP
|
$177.85
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3008762401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.28
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
|
|
HPV HIGH-RISK TYPES
|
Facility
|
OP
|
$177.85
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3008762401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.39
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.03
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.03
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$80.03
|
|
