|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.53
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare VA CCN |
$77.85
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$87.43 |
| Rate for Payer: Aetna of VT Commercial |
$64.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.69
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$35.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$50.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare VA CCN |
$33.12
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.69
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$35.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$50.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare VA CCN |
$33.12
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.85
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare VA CCN |
$31.05
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.20
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
OFFICE /OP EST SF MDM 10-19 M
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
9609921202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$98.70 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.69
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$35.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$50.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.12
|
| Rate for Payer: United Healthcare VA CCN |
$33.12
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna of VT Commercial |
$367.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$313.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$307.67
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$309.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.15
|
| Rate for Payer: Multiplan Commercial |
$359.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.15
|
| Rate for Payer: United Healthcare Commercial |
$367.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.15
|
| Rate for Payer: United Healthcare VA CCN |
$174.15
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$449.98 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Aetna of VT Commercial |
$577.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$449.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$449.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$516.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$510.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$486.40
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$486.40
|
| Rate for Payer: Multiplan Commercial |
$565.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$516.80
|
| Rate for Payer: United Healthcare Commercial |
$577.60
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
5109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.60
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Aetna of VT Commercial |
$577.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$544.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$269.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$544.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$366.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$516.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$492.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.36
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$486.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$486.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$565.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$516.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$273.60
|
| Rate for Payer: United Healthcare Commercial |
$577.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.60
|
| Rate for Payer: United Healthcare VA CCN |
$273.60
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
5109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.49
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare VA CCN |
$99.90
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$286.42 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna of VT Commercial |
$367.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$286.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$286.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$328.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.60
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$309.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.60
|
| Rate for Payer: Multiplan Commercial |
$359.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.95
|
| Rate for Payer: United Healthcare Commercial |
$367.65
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna of VT Commercial |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$184.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.81
|
| Rate for Payer: Multiplan Commercial |
$359.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare Commercial |
$261.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare VA CCN |
$169.98
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
9609920501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$571.52 |
| Rate for Payer: Aetna of VT Commercial |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$184.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.81
|
| Rate for Payer: Multiplan Commercial |
$565.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare Commercial |
$261.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare VA CCN |
$169.98
|
|
|
OFFICE/OP NEW HIGH MDM 60-74 M
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
5109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.25 |
| Max. Negotiated Rate |
$343.04 |
| Rate for Payer: Aetna of VT Commercial |
$208.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$175.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.81
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare Commercial |
$261.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.98
|
| Rate for Payer: United Healthcare VA CCN |
$169.98
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
9609920301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Aetna of VT Commercial |
$387.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$245.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.36
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$379.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$183.60
|
| Rate for Payer: United Healthcare Commercial |
$387.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.60
|
| Rate for Payer: United Healthcare VA CCN |
$183.60
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
5109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$173.32 |
| Rate for Payer: Aetna of VT Commercial |
$136.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.55
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$83.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.15
|
| Rate for Payer: Multiplan Commercial |
$134.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.60
|
| Rate for Payer: United Healthcare Commercial |
$117.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.60
|
| Rate for Payer: United Healthcare VA CCN |
$76.60
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
5109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Aetna of VT Commercial |
$137.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.00
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$116.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$134.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.25
|
| Rate for Payer: United Healthcare Commercial |
$137.75
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
9609920301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$301.96 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Aetna of VT Commercial |
$387.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$326.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$379.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.80
|
| Rate for Payer: United Healthcare Commercial |
$387.60
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
9609920302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
5109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: Aetna of VT Commercial |
$137.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.28
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$116.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$134.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.25
|
| Rate for Payer: United Healthcare Commercial |
$137.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.25
|
| Rate for Payer: United Healthcare VA CCN |
$65.25
|
|
|
OFFICE/OP NEW LOW MDM 30-44 M
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
9609920302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$247.22 |
| Rate for Payer: Aetna of VT Commercial |
$247.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.55
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$83.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.15
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.60
|
| Rate for Payer: United Healthcare Commercial |
$117.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.60
|
| Rate for Payer: United Healthcare VA CCN |
$76.60
|
|
