|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
9609507601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Aetna of VT Commercial |
$927.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$432.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$874.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$587.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$829.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$775.92
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$780.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$780.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$439.20
|
| Rate for Payer: Multiplan Commercial |
$907.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$829.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$439.20
|
| Rate for Payer: United Healthcare Commercial |
$927.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.20
|
| Rate for Payer: United Healthcare VA CCN |
$439.20
|
|
|
INIT DAY HOSP NEONATE CARE
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 99477
|
| Hospital Charge Code |
9879947701
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$853.47 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,830.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,726.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$853.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,726.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,160.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,637.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,560.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$867.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,531.96
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,541.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,541.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,541.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$867.15
|
| Rate for Payer: Multiplan Commercial |
$1,792.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,637.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$867.15
|
| Rate for Payer: United Healthcare Commercial |
$1,830.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$867.15
|
| Rate for Payer: United Healthcare VA CCN |
$867.15
|
|
|
INIT DAY HOSP NEONATE CARE
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 99477
|
| Hospital Charge Code |
9879947701
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$1,426.17 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,830.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,426.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,426.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,637.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,618.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,541.60
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,541.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,541.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,541.60
|
| Rate for Payer: Multiplan Commercial |
$1,792.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,637.95
|
| Rate for Payer: United Healthcare Commercial |
$1,830.65
|
|
|
INITIAL HOSPITAL CARE 30M
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
9879922101
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$216.85 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna of VT Commercial |
$278.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.40
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.40
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.05
|
| Rate for Payer: United Healthcare Commercial |
$278.35
|
|
|
INITIAL HOSPITAL CARE 30M
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
9879922101
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna of VT Commercial |
$278.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$176.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$249.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.94
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.85
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.85
|
| Rate for Payer: United Healthcare Commercial |
$278.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.85
|
| Rate for Payer: United Healthcare VA CCN |
$131.85
|
|
|
INITIAL HOSPITAL CARE 30M
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
9879922101
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.77 |
| Max. Negotiated Rate |
$275.42 |
| Rate for Payer: Aetna of VT Commercial |
$275.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.19
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cash Price |
$146.50
|
| Rate for Payer: Cigna Commercial |
$83.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.77
|
| Rate for Payer: Multiplan Commercial |
$272.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Commercial |
$118.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare VA CCN |
$76.77
|
|
|
INITIAL HOSPITAL CARE 50M
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
9879922201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$239.79 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of VT Commercial |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$259.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$259.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$301.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.40
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
|
|
INITIAL HOSPITAL CARE 50M
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
9879922201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna of VT Commercial |
$304.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.08
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$132.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.83
|
| Rate for Payer: Multiplan Commercial |
$301.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.83
|
| Rate for Payer: United Healthcare Commercial |
$187.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.83
|
| Rate for Payer: United Healthcare VA CCN |
$121.83
|
|
|
INITIAL HOSPITAL CARE 50M
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
9879922201
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna of VT Commercial |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.58
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$259.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$259.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$259.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.80
|
| Rate for Payer: Multiplan Commercial |
$301.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.80
|
| Rate for Payer: United Healthcare Commercial |
$307.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.80
|
| Rate for Payer: United Healthcare VA CCN |
$145.80
|
|
|
INITIAL HOSPITAL CARE 70 M
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
9879922301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$252.45 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Aetna of VT Commercial |
$541.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$510.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$510.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$343.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$461.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$453.15
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$530.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.50
|
| Rate for Payer: United Healthcare Commercial |
$541.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.50
|
| Rate for Payer: United Healthcare VA CCN |
$256.50
|
|
|
INITIAL HOSPITAL CARE 70 M
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
9879922301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$251.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$251.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$295.20
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$176.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.55
|
| Rate for Payer: Multiplan Commercial |
$530.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.55
|
| Rate for Payer: United Healthcare Commercial |
$250.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: United Healthcare VA CCN |
$162.55
|
|
|
INITIAL HOSPITAL CARE 70 M
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
9879922301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$421.86 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Aetna of VT Commercial |
$541.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.00
|
| Rate for Payer: Multiplan Commercial |
$530.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.50
|
| Rate for Payer: United Healthcare Commercial |
$541.50
|
|
|
INITIAL OBSERVATION CARE 30M
|
Facility
|
IP
|
$1,843.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
9829921801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,364.00 |
| Max. Negotiated Rate |
$1,750.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,750.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,364.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,364.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,566.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,548.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,474.40
|
| Rate for Payer: Cash Price |
$921.50
|
| Rate for Payer: Cigna Commercial |
$1,474.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,474.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,474.40
|
| Rate for Payer: Multiplan Commercial |
$1,713.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,566.55
|
| Rate for Payer: United Healthcare Commercial |
$1,750.85
|
|
|
INITIAL OBSERVATION CARE 30M
|
Facility
|
OP
|
$1,843.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
9829921801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$816.26 |
| Max. Negotiated Rate |
$1,750.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,750.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,651.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$816.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,651.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,109.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,566.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,492.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$829.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,465.18
|
| Rate for Payer: Cash Price |
$921.50
|
| Rate for Payer: Cigna Commercial |
$1,474.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,474.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,474.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$829.35
|
| Rate for Payer: Multiplan Commercial |
$1,713.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,566.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$829.35
|
| Rate for Payer: United Healthcare Commercial |
$1,750.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.35
|
| Rate for Payer: United Healthcare VA CCN |
$829.35
|
|
|
INITIAL OBSERVATION CARE 30M
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
9829921801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$1,732.42 |
| Rate for Payer: Aetna of VT Commercial |
$1,732.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,651.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,651.14
|
| Rate for Payer: Cash Price |
$921.50
|
| Rate for Payer: Multiplan Commercial |
$1,713.99
|
| Rate for Payer: United Healthcare Commercial |
$1,566.55
|
| Rate for Payer: United Healthcare VA CCN |
$737.20
|
|
|
INITIAL OBSERVATION CARE 50M
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
9829921901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.23 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
|
|
INITIAL OBSERVATION CARE 50M
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
9829921901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare VA CCN |
$126.00
|
|
|
INITIAL OBSERVATION CARE 50M
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
9829921901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna of VT Commercial |
$263.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: United Healthcare Commercial |
$238.00
|
| Rate for Payer: United Healthcare VA CCN |
$112.00
|
|
|
INITIAL OBSERVATION CARE 70M
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
9829922001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$240.40 |
| Max. Negotiated Rate |
$564.94 |
| Rate for Payer: Aetna of VT Commercial |
$564.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.44
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: United Healthcare Commercial |
$510.85
|
| Rate for Payer: United Healthcare VA CCN |
$240.40
|
|
|
INITIAL OBSERVATION CARE 70M
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
9829922001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna of VT Commercial |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$444.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$444.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$504.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$480.80
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.80
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.85
|
| Rate for Payer: United Healthcare Commercial |
$570.95
|
|
|
INITIAL OBSERVATION CARE 70M
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
9829922001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna of VT Commercial |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$266.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$486.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$477.80
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$270.45
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.45
|
| Rate for Payer: United Healthcare Commercial |
$570.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.45
|
| Rate for Payer: United Healthcare VA CCN |
$270.45
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
960G040201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
510G040201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.05
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare VA CCN |
$85.50
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
960G040202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna of VT Commercial |
$449.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$397.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.40
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.40
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.05
|
| Rate for Payer: United Healthcare Commercial |
$449.35
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
960G040202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.49 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna of VT Commercial |
$449.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$284.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.04
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.85
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare Commercial |
$449.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare VA CCN |
$212.85
|
|
