|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$350.24
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
3799915601
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$259.21 |
| Max. Negotiated Rate |
$332.73 |
| Rate for Payer: Aetna of VT Commercial |
$332.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$259.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$259.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.19
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Commercial |
$280.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.19
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.70
|
| Rate for Payer: United Healthcare Commercial |
$332.73
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$255.40
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
4509915601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.32
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$350.24
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
3799915601
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$332.73 |
| Rate for Payer: Aetna of VT Commercial |
$332.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$313.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$313.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.44
|
| Rate for Payer: Cash Price |
$175.12
|
| Rate for Payer: Cigna Commercial |
$280.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.61
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.61
|
| Rate for Payer: United Healthcare Commercial |
$332.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.61
|
| Rate for Payer: United Healthcare VA CCN |
$157.61
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
9819915602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna of VT Commercial |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.88
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.80
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.80
|
| Rate for Payer: United Healthcare VA CCN |
$118.80
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$255.40
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
4509915601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.04
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.93
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.93
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.93
|
| Rate for Payer: United Healthcare VA CCN |
$114.93
|
|
|
MOD SED SAME INIT 15 MINS <5
|
Facility
|
IP
|
$461.94
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
3799915101
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$341.88 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna of VT Commercial |
$438.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.55
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$369.55
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.65
|
| Rate for Payer: United Healthcare Commercial |
$438.84
|
|
|
MOD SED SAME INIT 15 MINS <5
|
Facility
|
OP
|
$461.94
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
3799915101
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$204.59 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna of VT Commercial |
$438.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$413.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$413.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.24
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$369.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$207.87
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.87
|
| Rate for Payer: United Healthcare Commercial |
$438.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.87
|
| Rate for Payer: United Healthcare VA CCN |
$207.87
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
IP
|
$461.94
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
4509915101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.88 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna of VT Commercial |
$438.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.55
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$369.55
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.65
|
| Rate for Payer: United Healthcare Commercial |
$438.84
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.20
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$168.26 |
| Rate for Payer: Aetna of VT Commercial |
$168.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.56
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.46
|
| Rate for Payer: United Healthcare Commercial |
$34.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.46
|
| Rate for Payer: United Healthcare VA CCN |
$22.46
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.31
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.55
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare VA CCN |
$80.55
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
9819915101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.56
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.46
|
| Rate for Payer: United Healthcare Commercial |
$34.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.46
|
| Rate for Payer: United Healthcare VA CCN |
$22.46
|
|
|
MOD SED SAME PHYS/QHP <5 YRS
|
Facility
|
OP
|
$461.94
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
4509915101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.59 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna of VT Commercial |
$438.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$413.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$413.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$392.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$207.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.24
|
| Rate for Payer: Cash Price |
$230.97
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$369.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$369.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$207.87
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$392.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$207.87
|
| Rate for Payer: United Healthcare Commercial |
$438.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.87
|
| Rate for Payer: United Healthcare VA CCN |
$207.87
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
9819915202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.55
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare VA CCN |
$62.55
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
9819915202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Aetna of VT Commercial |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.84
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$13.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.78
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.16
|
| Rate for Payer: United Healthcare VA CCN |
$11.16
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$207.83
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
3799915201
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.26
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$357.09
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
4509915201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$339.24 |
| Rate for Payer: Aetna of VT Commercial |
$339.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$214.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$303.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$160.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.89
|
| Rate for Payer: Cash Price |
$178.54
|
| Rate for Payer: Cigna Commercial |
$285.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.69
|
| Rate for Payer: Multiplan Commercial |
$332.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$160.69
|
| Rate for Payer: United Healthcare Commercial |
$339.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.69
|
| Rate for Payer: United Healthcare VA CCN |
$160.69
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$357.09
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
4509915201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.28 |
| Max. Negotiated Rate |
$339.24 |
| Rate for Payer: Aetna of VT Commercial |
$339.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$303.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.67
|
| Rate for Payer: Cash Price |
$178.54
|
| Rate for Payer: Cigna Commercial |
$285.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.67
|
| Rate for Payer: Multiplan Commercial |
$332.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.53
|
| Rate for Payer: United Healthcare Commercial |
$339.24
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
9819915202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.20
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
|
|
MOD SED SAME PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$207.83
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
3799915201
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.22
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.52
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.52
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.52
|
| Rate for Payer: United Healthcare VA CCN |
$93.52
|
|
|
MOD SED SAME PHYS/QHP EA
|
Facility
|
IP
|
$303.59
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
4509915301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$288.41 |
| Rate for Payer: Aetna of VT Commercial |
$288.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.87
|
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Cigna Commercial |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.87
|
| Rate for Payer: Multiplan Commercial |
$282.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.05
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
|
|
MOD SED SAME PHYS/QHP EA
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
9819915302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.08
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare VA CCN |
$10.80
|
|
|
MOD SED SAME PHYS/QHP EA
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
9819915302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
|
