|
NEG PRESS WOUND TX >50 CM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.02 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.79
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.45
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.45
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.45
|
| Rate for Payer: United Healthcare VA CCN |
$90.45
|
|
|
NEG PRESS WOUND TX >50 CM
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$535.90 |
| Rate for Payer: Aetna of VT Commercial |
$188.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$26.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.57
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare VA CCN |
$22.32
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9829760801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.80
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
5109760801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$398.17 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Aetna of VT Commercial |
$854.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$541.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$728.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.71
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$719.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.55
|
| Rate for Payer: Multiplan Commercial |
$836.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.55
|
| Rate for Payer: United Healthcare Commercial |
$854.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.55
|
| Rate for Payer: United Healthcare VA CCN |
$404.55
|
|
|
NEG PRESS WOUND TX >50 CM
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$1,034.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,034.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$26.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.57
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare VA CCN |
$22.32
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.80
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9829760801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$89.02 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.79
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.45
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.45
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.45
|
| Rate for Payer: United Healthcare VA CCN |
$90.45
|
|
|
NEG PRS WND THER DME>50 SQCM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
9829760601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna of VT Commercial |
$143.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.05
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.95
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.95
|
| Rate for Payer: United Healthcare Commercial |
$143.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.95
|
| Rate for Payer: United Healthcare VA CCN |
$67.95
|
|
|
NEG PRS WND THER DME>50 SQCM
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
9829760601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$141.94 |
| Rate for Payer: Aetna of VT Commercial |
$141.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.52
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$31.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.77
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
NEG PRS WND THER DME>50 SQCM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
9829760601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna of VT Commercial |
$143.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.80
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.80
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.35
|
| Rate for Payer: United Healthcare Commercial |
$143.45
|
|
|
NEONATE CRIT CARE INITIAL
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
CPT 99468
|
| Hospital Charge Code |
9879946801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$1,818.99 |
| Max. Negotiated Rate |
$3,901.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,901.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,679.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,818.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,679.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,472.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,490.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,326.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,848.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,265.07
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$3,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,285.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,848.15
|
| Rate for Payer: Multiplan Commercial |
$3,819.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,490.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,848.15
|
| Rate for Payer: United Healthcare Commercial |
$3,901.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,848.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,848.15
|
|
|
NEONATE CRIT CARE INITIAL
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
CPT 99468
|
| Hospital Charge Code |
9879946801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$3,039.59 |
| Max. Negotiated Rate |
$3,901.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,901.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,039.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,039.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,490.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,449.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,285.60
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$3,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,285.60
|
| Rate for Payer: Multiplan Commercial |
$3,819.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,490.95
|
| Rate for Payer: United Healthcare Commercial |
$3,901.65
|
|
|
NEUROMUSCULAR REEDUCATION
|
Facility
|
OP
|
$113.86
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
4209711201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna of VT Commercial |
$108.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.52
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cigna Commercial |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.24
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.24
|
| Rate for Payer: United Healthcare VA CCN |
$51.24
|
|
|
NEUROMUSCULAR REEDUCATION
|
Facility
|
IP
|
$113.86
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
4309711201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna of VT Commercial |
$108.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.09
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cigna Commercial |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.09
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.78
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
|
|
NEUROMUSCULAR REEDUCATION
|
Facility
|
IP
|
$113.86
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
4209711201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna of VT Commercial |
$108.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.09
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cigna Commercial |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.09
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.78
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
|
|
NEUROMUSCULAR REEDUCATION
|
Professional
|
Both
|
$113.86
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
4209711201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$107.03 |
| Rate for Payer: Aetna of VT Commercial |
$107.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.38
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cigna Commercial |
$39.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.76
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.76
|
| Rate for Payer: United Healthcare Commercial |
$48.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.76
|
| Rate for Payer: United Healthcare VA CCN |
$31.76
|
|
|
NEUROMUSCULAR REEDUCATION
|
Facility
|
OP
|
$113.86
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
4309711201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$108.17 |
| Rate for Payer: Aetna of VT Commercial |
$108.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.52
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cigna Commercial |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.24
|
| Rate for Payer: Multiplan Commercial |
$105.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$108.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.24
|
| Rate for Payer: United Healthcare VA CCN |
$51.24
|
|
|
NEUTRALIZATION TEST VIRAL
|
Professional
|
Both
|
$247.13
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3008638201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.67 |
| Max. Negotiated Rate |
$232.30 |
| Rate for Payer: Aetna of VT Commercial |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.90
|
| Rate for Payer: Cash Price |
$123.56
|
| Rate for Payer: Cash Price |
$123.56
|
| Rate for Payer: Cigna Commercial |
$20.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.67
|
| Rate for Payer: Multiplan Commercial |
$229.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$26.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare VA CCN |
$16.91
|
|
|
NEUTRALIZATION TEST VIRAL
|
Facility
|
OP
|
$247.13
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3008638201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$234.77 |
| Rate for Payer: Aetna of VT Commercial |
$234.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.47
|
| Rate for Payer: Cash Price |
$123.56
|
| Rate for Payer: Cash Price |
$123.56
|
| Rate for Payer: Cigna Commercial |
$197.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.21
|
| Rate for Payer: Multiplan Commercial |
$229.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.21
|
| Rate for Payer: United Healthcare Commercial |
$234.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare VA CCN |
$111.21
|
|
|
NEUTRALIZATION TEST VIRAL
|
Facility
|
IP
|
$247.13
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3008638201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.90 |
| Max. Negotiated Rate |
$234.77 |
| Rate for Payer: Aetna of VT Commercial |
$234.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.70
|
| Rate for Payer: Cash Price |
$123.56
|
| Rate for Payer: Cigna Commercial |
$197.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.70
|
| Rate for Payer: Multiplan Commercial |
$229.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.06
|
| Rate for Payer: United Healthcare Commercial |
$234.77
|
|
|
NEXPLANON
|
Facility
|
OP
|
$3,388.87
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
6360049421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,500.93 |
| Max. Negotiated Rate |
$3,340.23 |
| Rate for Payer: Aetna of VT Commercial |
$3,219.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,500.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,040.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,880.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,744.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,524.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,694.15
|
| Rate for Payer: Cash Price |
$1,694.43
|
| Rate for Payer: Cash Price |
$1,694.43
|
| Rate for Payer: Cigna Commercial |
$2,711.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,711.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,711.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,524.99
|
| Rate for Payer: Multiplan Commercial |
$3,151.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,880.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,524.99
|
| Rate for Payer: United Healthcare Commercial |
$3,219.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,524.99
|
| Rate for Payer: United Healthcare VA CCN |
$1,524.99
|
|
|
NEXPLANON
|
Professional
|
Both
|
$3,388.87
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
6360049421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,124.00 |
| Max. Negotiated Rate |
$3,340.23 |
| Rate for Payer: Aetna of VT Commercial |
$3,185.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,340.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,340.23
|
| Rate for Payer: Cash Price |
$1,694.43
|
| Rate for Payer: Cash Price |
$1,694.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,179.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,179.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,384.68
|
| Rate for Payer: Multiplan Commercial |
$3,151.65
|
| Rate for Payer: United Healthcare Commercial |
$2,880.54
|
| Rate for Payer: United Healthcare VA CCN |
$1,124.00
|
|
|
NEXPLANON
|
Facility
|
IP
|
$3,388.87
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
6360049421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,508.10 |
| Max. Negotiated Rate |
$3,219.43 |
| Rate for Payer: Aetna of VT Commercial |
$3,219.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,508.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,508.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,880.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,846.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,711.10
|
| Rate for Payer: Cash Price |
$1,694.43
|
| Rate for Payer: Cigna Commercial |
$2,711.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,711.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,711.10
|
| Rate for Payer: Multiplan Commercial |
$3,151.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,880.54
|
| Rate for Payer: United Healthcare Commercial |
$3,219.43
|
|
|
NEXPLANON IUD
|
Facility
|
OP
|
$4,858.52
|
|
| Hospital Charge Code |
2720049421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,151.84 |
| Max. Negotiated Rate |
$4,615.59 |
| Rate for Payer: Aetna of VT Commercial |
$4,615.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,352.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,151.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,352.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,924.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,129.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,935.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,186.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,862.52
|
| Rate for Payer: Cash Price |
$2,429.26
|
| Rate for Payer: Cigna Commercial |
$3,886.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,886.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,886.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,186.33
|
| Rate for Payer: Multiplan Commercial |
$4,518.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,129.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,186.33
|
| Rate for Payer: United Healthcare Commercial |
$4,615.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,186.33
|
| Rate for Payer: United Healthcare VA CCN |
$2,186.33
|
|
|
NEXPLANON IUD
|
Facility
|
IP
|
$4,858.52
|
|
| Hospital Charge Code |
2720049421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,595.79 |
| Max. Negotiated Rate |
$4,615.59 |
| Rate for Payer: Aetna of VT Commercial |
$4,615.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,595.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,595.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,129.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,081.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,886.82
|
| Rate for Payer: Cash Price |
$2,429.26
|
| Rate for Payer: Cigna Commercial |
$3,886.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,886.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,886.82
|
| Rate for Payer: Multiplan Commercial |
$4,518.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,129.74
|
| Rate for Payer: United Healthcare Commercial |
$4,615.59
|
|
