|
MANUAL THERAPY 1/> REGIONS
|
Facility
|
OP
|
$141.50
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
4209714001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna of VT Commercial |
$134.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.49
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.67
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.67
|
| Rate for Payer: United Healthcare Commercial |
$134.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.67
|
| Rate for Payer: United Healthcare VA CCN |
$63.67
|
|
|
MANUAL THERAPY 1/> REGIONS
|
Professional
|
Both
|
$141.50
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
4209714001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$133.01 |
| Rate for Payer: Aetna of VT Commercial |
$133.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.28
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$31.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.92
|
| Rate for Payer: United Healthcare Commercial |
$41.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.92
|
| Rate for Payer: United Healthcare VA CCN |
$26.92
|
|
|
MANUAL THERAPY 1/> REGIONS
|
Facility
|
IP
|
$141.50
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
4209714001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna of VT Commercial |
$134.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.20
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.20
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$134.43
|
|
|
MANUAL THERAPY 1/> REGIONS
|
Facility
|
IP
|
$141.50
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
4309714001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna of VT Commercial |
$134.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.20
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.20
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.28
|
| Rate for Payer: United Healthcare Commercial |
$134.43
|
|
|
MANUAL THERAPY 1/> REGIONS
|
Facility
|
OP
|
$141.50
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
4309714001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$134.43 |
| Rate for Payer: Aetna of VT Commercial |
$134.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.49
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.67
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.67
|
| Rate for Payer: United Healthcare Commercial |
$134.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.67
|
| Rate for Payer: United Healthcare VA CCN |
$63.67
|
|
|
MARK BIO SITE PETITE
|
Facility
|
IP
|
$341.84
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna of VT Commercial |
$324.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.47
|
| Rate for Payer: Cash Price |
$170.92
|
| Rate for Payer: Cigna Commercial |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.47
|
| Rate for Payer: Multiplan Commercial |
$317.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.56
|
| Rate for Payer: United Healthcare Commercial |
$324.75
|
|
|
MARK BIO SITE PETITE
|
Facility
|
OP
|
$341.84
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna of VT Commercial |
$324.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$205.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.76
|
| Rate for Payer: Cash Price |
$170.92
|
| Rate for Payer: Cigna Commercial |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.83
|
| Rate for Payer: Multiplan Commercial |
$317.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.83
|
| Rate for Payer: United Healthcare Commercial |
$324.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.83
|
| Rate for Payer: United Healthcare VA CCN |
$153.83
|
|
|
MARK BIO SITE STANDARD
|
Facility
|
OP
|
$297.64
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.82 |
| Max. Negotiated Rate |
$282.76 |
| Rate for Payer: Aetna of VT Commercial |
$282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$179.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$252.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.62
|
| Rate for Payer: Cash Price |
$148.82
|
| Rate for Payer: Cigna Commercial |
$238.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$238.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$238.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.94
|
| Rate for Payer: Multiplan Commercial |
$276.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.94
|
| Rate for Payer: United Healthcare Commercial |
$282.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.94
|
| Rate for Payer: United Healthcare VA CCN |
$133.94
|
|
|
MARK BIO SITE STANDARD
|
Facility
|
IP
|
$297.64
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.28 |
| Max. Negotiated Rate |
$282.76 |
| Rate for Payer: Aetna of VT Commercial |
$282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$252.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$238.11
|
| Rate for Payer: Cash Price |
$148.82
|
| Rate for Payer: Cigna Commercial |
$238.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$238.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$238.11
|
| Rate for Payer: Multiplan Commercial |
$276.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.99
|
| Rate for Payer: United Healthcare Commercial |
$282.76
|
|
|
MARK BIO SITE SUPERFICIAL
|
Facility
|
IP
|
$341.84
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna of VT Commercial |
$324.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.47
|
| Rate for Payer: Cash Price |
$170.92
|
| Rate for Payer: Cigna Commercial |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.47
|
| Rate for Payer: Multiplan Commercial |
$317.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.56
|
| Rate for Payer: United Healthcare Commercial |
$324.75
|
|
|
MARK BIO SITE SUPERFICIAL
|
Facility
|
OP
|
$341.84
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780023381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna of VT Commercial |
$324.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$205.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.76
|
| Rate for Payer: Cash Price |
$170.92
|
| Rate for Payer: Cigna Commercial |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.83
|
| Rate for Payer: Multiplan Commercial |
$317.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.83
|
| Rate for Payer: United Healthcare Commercial |
$324.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.83
|
| Rate for Payer: United Healthcare VA CCN |
$153.83
|
|
|
MARKER 14GSS BREAST BIOPSY
|
Facility
|
OP
|
$40.16
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780021181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna of VT Commercial |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.93
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cigna Commercial |
$32.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.07
|
| Rate for Payer: Multiplan Commercial |
$37.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.07
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.07
|
| Rate for Payer: United Healthcare VA CCN |
$18.07
|
|
|
MARKER 14GSS BREAST BIOPSY
|
Facility
|
IP
|
$40.16
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780021181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna of VT Commercial |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.13
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cigna Commercial |
$32.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.13
|
| Rate for Payer: Multiplan Commercial |
$37.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.14
|
| Rate for Payer: United Healthcare Commercial |
$38.15
|
|
|
MARKER 14GT BREAST BIOPSY
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780021191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna of VT Commercial |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.09
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna Commercial |
$33.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.73
|
| Rate for Payer: Multiplan Commercial |
$38.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.73
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.73
|
| Rate for Payer: United Healthcare VA CCN |
$18.73
|
|
|
MARKER 14GT BREAST BIOPSY
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
2780021191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna of VT Commercial |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.30
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cigna Commercial |
$33.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$38.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.38
|
| Rate for Payer: United Healthcare Commercial |
$39.54
|
|
|
MASK STD 5 COMFORT STAR ANES
|
Facility
|
IP
|
$2.68
|
|
| Hospital Charge Code |
2700022261
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna of VT Commercial |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.14
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna Commercial |
$2.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.14
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.28
|
| Rate for Payer: United Healthcare Commercial |
$2.55
|
|
|
MASK STD 5 COMFORT STAR ANES
|
Facility
|
OP
|
$2.68
|
|
| Hospital Charge Code |
2700022261
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna of VT Commercial |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.13
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cigna Commercial |
$2.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.21
|
| Rate for Payer: Multiplan Commercial |
$2.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$2.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.21
|
| Rate for Payer: United Healthcare VA CCN |
$1.21
|
|
|
MASSAGE THERAPY
|
Facility
|
OP
|
$173.71
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
4209712401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of VT Commercial |
$165.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.10
|
| Rate for Payer: Cash Price |
$86.86
|
| Rate for Payer: Cigna Commercial |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.17
|
| Rate for Payer: Multiplan Commercial |
$161.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.17
|
| Rate for Payer: United Healthcare Commercial |
$165.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.17
|
| Rate for Payer: United Healthcare VA CCN |
$78.17
|
|
|
MASSAGE THERAPY
|
Facility
|
IP
|
$173.71
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
4209712401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of VT Commercial |
$165.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.97
|
| Rate for Payer: Cash Price |
$86.86
|
| Rate for Payer: Cigna Commercial |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.97
|
| Rate for Payer: Multiplan Commercial |
$161.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.65
|
| Rate for Payer: United Healthcare Commercial |
$165.02
|
|
|
MASS SPECTROMETRY QUAL/QUAN
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3008378901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.40
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
|
|
MASS SPECTROMETRY QUAL/QUAN
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3008378901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
MASTECTOMY GYNECOMASTIA
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
9821930001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$406.93 |
| Max. Negotiated Rate |
$1,414.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,414.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,348.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$419.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,348.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$569.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$763.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$763.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$763.97
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cigna Commercial |
$740.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$896.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$896.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$542.47
|
| Rate for Payer: Multiplan Commercial |
$1,399.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$577.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$406.93
|
| Rate for Payer: United Healthcare Commercial |
$625.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$406.93
|
| Rate for Payer: United Healthcare VA CCN |
$406.93
|
|
|
MASTECTOMY GYNECOMASTIA
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
9821930001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,113.85 |
| Max. Negotiated Rate |
$1,429.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,429.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,113.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,113.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,279.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,264.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,204.00
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cigna Commercial |
$1,204.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,204.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,399.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,279.25
|
| Rate for Payer: United Healthcare Commercial |
$1,429.75
|
|
|
MASTECTOMY GYNECOMASTIA
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
9821930001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$1,429.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,429.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,348.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$666.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,348.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$906.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,279.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,219.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$677.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,196.47
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cigna Commercial |
$1,204.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,204.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,204.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$677.25
|
| Rate for Payer: Multiplan Commercial |
$1,399.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,279.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$677.25
|
| Rate for Payer: United Healthcare Commercial |
$1,429.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$677.25
|
| Rate for Payer: United Healthcare VA CCN |
$677.25
|
|
|
MASTECTOMY PARTIAL
|
Facility
|
OP
|
$8,366.00
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
9821930101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,705.30 |
| Max. Negotiated Rate |
$7,947.70 |
| Rate for Payer: Aetna of VT Commercial |
$7,947.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,495.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,705.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,495.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,036.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,111.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,776.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,764.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,650.97
|
| Rate for Payer: Cash Price |
$4,183.00
|
| Rate for Payer: Cigna Commercial |
$6,692.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,692.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,692.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,764.70
|
| Rate for Payer: Multiplan Commercial |
$7,780.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,111.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,764.70
|
| Rate for Payer: United Healthcare Commercial |
$7,947.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,764.70
|
| Rate for Payer: United Healthcare VA CCN |
$3,764.70
|
|
