|
OB ANTEP CESAREAN DLVR & POSTP
|
Facility
|
IP
|
$5,152.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
9695951001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$3,813.00 |
| Max. Negotiated Rate |
$4,894.40 |
| Rate for Payer: Aetna of VT Commercial |
$4,894.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,813.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,813.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,379.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,327.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,121.60
|
| Rate for Payer: Cash Price |
$2,576.00
|
| Rate for Payer: Cigna Commercial |
$4,121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,121.60
|
| Rate for Payer: Multiplan Commercial |
$4,791.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,379.20
|
| Rate for Payer: United Healthcare Commercial |
$4,894.40
|
|
|
OB ANTEP CESAREAN DLVR & POSTP
|
Professional
|
Both
|
$5,152.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
9695951001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,418.50 |
| Max. Negotiated Rate |
$4,842.88 |
| Rate for Payer: Aetna of VT Commercial |
$4,842.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,615.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,491.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,615.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,385.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,808.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,808.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,781.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,808.64
|
| Rate for Payer: Cash Price |
$2,576.00
|
| Rate for Payer: Cash Price |
$2,576.00
|
| Rate for Payer: Cash Price |
$2,576.00
|
| Rate for Payer: Cigna Commercial |
$2,659.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,160.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,160.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,418.50
|
| Rate for Payer: Multiplan Commercial |
$4,791.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,418.50
|
| Rate for Payer: United Healthcare Commercial |
$3,720.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,418.50
|
| Rate for Payer: United Healthcare VA CCN |
$2,418.50
|
|
|
OBSERVATION CARE DISCHARGE
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
9829921701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$179.54 |
| Rate for Payer: Aetna of VT Commercial |
$179.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.12
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: United Healthcare Commercial |
$162.35
|
| Rate for Payer: United Healthcare VA CCN |
$76.40
|
|
|
OBSERVATION CARE DISCHARGE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
9829921701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.80
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
|
|
OBSERVATION CARE DISCHARGE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
9829921701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.84
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.95
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare VA CCN |
$85.95
|
|
|
OBSERV/HOSP SAME DATE 40 MIN
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
9879923401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$272.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$294.40
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
|
|
OBSERV/HOSP SAME DATE 40 MIN
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
9879923401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$162.99 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna of VT Commercial |
$349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.56
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$294.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$294.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.60
|
| Rate for Payer: United Healthcare VA CCN |
$165.60
|
|
|
OBSERV/HOSP SAME DATE 40 MIN
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
9879923401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna of VT Commercial |
$345.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.59
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$99.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$149.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$149.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.14
|
| Rate for Payer: Multiplan Commercial |
$342.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.14
|
| Rate for Payer: United Healthcare Commercial |
$140.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.14
|
| Rate for Payer: United Healthcare VA CCN |
$91.14
|
|
|
OBS/HOSP CARE SAME DATE 50 M
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
9879923501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$148.65 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Aetna of VT Commercial |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$312.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.35
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$162.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.66
|
| Rate for Payer: Multiplan Commercial |
$348.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.65
|
| Rate for Payer: United Healthcare Commercial |
$228.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.65
|
| Rate for Payer: United Healthcare VA CCN |
$148.65
|
|
|
OBS/HOSP CARE SAME DATE 50 M
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
9879923501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$166.09 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna of VT Commercial |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$335.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$335.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.12
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$300.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$300.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$348.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$168.75
|
| Rate for Payer: United Healthcare Commercial |
$356.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.75
|
| Rate for Payer: United Healthcare VA CCN |
$168.75
|
|
|
OBS/HOSP CARE SAME DATE 50 M
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
9879923501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$277.54 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna of VT Commercial |
$356.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$277.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$277.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$300.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$300.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$348.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$318.75
|
| Rate for Payer: United Healthcare Commercial |
$356.25
|
|
|
OBS/HOSP CARE SAME DATE 55 M
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
9879923601
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$174.95 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Aetna of VT Commercial |
$375.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$353.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$353.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$335.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$177.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.02
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$316.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$316.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$316.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.75
|
| Rate for Payer: Multiplan Commercial |
$367.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.75
|
| Rate for Payer: United Healthcare Commercial |
$375.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.75
|
| Rate for Payer: United Healthcare VA CCN |
$177.75
|
|
|
OBS/HOSP CARE SAME DATE 55 M
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
9879923601
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$390.09 |
| Rate for Payer: Aetna of VT Commercial |
$371.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$251.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$251.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$271.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$390.09
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$212.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$317.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$317.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.09
|
| Rate for Payer: Multiplan Commercial |
$367.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.08
|
| Rate for Payer: United Healthcare Commercial |
$298.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.08
|
| Rate for Payer: United Healthcare VA CCN |
$194.08
|
|
|
OBS/HOSP CARE SAME DATE 55 M
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
9879923601
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$292.34 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Aetna of VT Commercial |
$375.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$335.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$316.00
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$316.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$316.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$316.00
|
| Rate for Payer: Multiplan Commercial |
$367.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.75
|
| Rate for Payer: United Healthcare Commercial |
$375.25
|
|
|
OBSTETRICAL CARE
|
Facility
|
IP
|
$5,153.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
9695940001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$3,813.74 |
| Max. Negotiated Rate |
$4,895.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,895.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,813.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,813.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,380.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,328.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,122.40
|
| Rate for Payer: Cash Price |
$2,576.50
|
| Rate for Payer: Cigna Commercial |
$4,122.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,122.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,122.40
|
| Rate for Payer: Multiplan Commercial |
$4,792.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,380.05
|
| Rate for Payer: United Healthcare Commercial |
$4,895.35
|
|
|
OBSTETRICAL CARE
|
Facility
|
OP
|
$5,153.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
9695940001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,282.26 |
| Max. Negotiated Rate |
$4,895.35 |
| Rate for Payer: Aetna of VT Commercial |
$4,895.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,616.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,282.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,616.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,102.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,380.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,173.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,318.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,096.64
|
| Rate for Payer: Cash Price |
$2,576.50
|
| Rate for Payer: Cigna Commercial |
$4,122.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,122.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,122.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,318.85
|
| Rate for Payer: Multiplan Commercial |
$4,792.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,380.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,318.85
|
| Rate for Payer: United Healthcare Commercial |
$4,895.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,318.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,318.85
|
|
|
OBSTETRICAL CARE
|
Professional
|
Both
|
$5,153.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
9695940001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,192.79 |
| Max. Negotiated Rate |
$4,843.82 |
| Rate for Payer: Aetna of VT Commercial |
$4,843.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,616.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,258.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,616.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,069.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,376.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,376.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,521.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,376.46
|
| Rate for Payer: Cash Price |
$2,576.50
|
| Rate for Payer: Cash Price |
$2,576.50
|
| Rate for Payer: Cash Price |
$2,576.50
|
| Rate for Payer: Cigna Commercial |
$2,409.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,745.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,745.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,192.79
|
| Rate for Payer: Multiplan Commercial |
$4,792.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,800.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,192.79
|
| Rate for Payer: United Healthcare Commercial |
$3,373.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,192.79
|
| Rate for Payer: United Healthcare VA CCN |
$2,192.79
|
|
|
OBSTETRIC PANEL
|
Facility
|
OP
|
$545.95
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
3008005501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$518.65 |
| Rate for Payer: Aetna of VT Commercial |
$518.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$241.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$328.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$442.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$245.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.03
|
| Rate for Payer: Cash Price |
$272.98
|
| Rate for Payer: Cash Price |
$272.98
|
| Rate for Payer: Cigna Commercial |
$436.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$436.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$436.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$245.68
|
| Rate for Payer: Multiplan Commercial |
$507.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$464.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$245.68
|
| Rate for Payer: United Healthcare Commercial |
$518.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.81
|
| Rate for Payer: United Healthcare VA CCN |
$245.68
|
|
|
OBSTETRIC PANEL
|
Facility
|
IP
|
$545.95
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
3008005501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$404.06 |
| Max. Negotiated Rate |
$518.65 |
| Rate for Payer: Aetna of VT Commercial |
$518.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$458.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$436.76
|
| Rate for Payer: Cash Price |
$272.98
|
| Rate for Payer: Cigna Commercial |
$436.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$436.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$436.76
|
| Rate for Payer: Multiplan Commercial |
$507.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$464.06
|
| Rate for Payer: United Healthcare Commercial |
$518.65
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.62
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare VA CCN |
$33.75
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of VT Commercial |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.78
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.81
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare VA CCN |
$17.12
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.62
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare VA CCN |
$33.75
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
960Q009101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of VT Commercial |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.78
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.81
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare VA CCN |
$17.12
|
|
