|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
5109924401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna of VT Commercial |
$328.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$309.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$309.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.07
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.70
|
| Rate for Payer: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.70
|
| Rate for Payer: United Healthcare Commercial |
$328.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.70
|
| Rate for Payer: United Healthcare VA CCN |
$155.70
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
5109924401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna of VT Commercial |
$328.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.80
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.80
|
| Rate for Payer: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.10
|
| Rate for Payer: United Healthcare Commercial |
$328.70
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9609924402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna of VT Commercial |
$328.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.80
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.80
|
| Rate for Payer: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.10
|
| Rate for Payer: United Healthcare Commercial |
$328.70
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9609924401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$649.54 |
| Rate for Payer: Aetna of VT Commercial |
$649.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$619.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$619.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$309.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.49
|
| Rate for Payer: Cash Price |
$345.50
|
| Rate for Payer: Cash Price |
$345.50
|
| Rate for Payer: Cigna Commercial |
$137.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.65
|
| Rate for Payer: Multiplan Commercial |
$642.63
|
| Rate for Payer: United Healthcare Commercial |
$587.35
|
| Rate for Payer: United Healthcare VA CCN |
$132.75
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
5109924501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$671.27 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.60
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
5109924501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$852.58 |
| Rate for Payer: Aetna of VT Commercial |
$852.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.81
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.86
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: United Healthcare Commercial |
$770.95
|
| Rate for Payer: United Healthcare VA CCN |
$177.63
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$401.71 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$546.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$408.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.07
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.15
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare VA CCN |
$408.15
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$671.27 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.60
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$852.58 |
| Rate for Payer: Aetna of VT Commercial |
$852.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.81
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.86
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: United Healthcare Commercial |
$770.95
|
| Rate for Payer: United Healthcare VA CCN |
$177.63
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$401.71 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$546.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$408.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.07
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.15
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare VA CCN |
$408.15
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
5109924501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.71 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$401.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$546.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$408.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$721.07
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$408.15
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.15
|
| Rate for Payer: United Healthcare VA CCN |
$408.15
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$671.27 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Aetna of VT Commercial |
$861.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$671.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$770.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$761.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$725.60
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$725.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$725.60
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$770.95
|
| Rate for Payer: United Healthcare Commercial |
$861.65
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9609924502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$852.58 |
| Rate for Payer: Aetna of VT Commercial |
$852.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$812.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$388.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.81
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.86
|
| Rate for Payer: Multiplan Commercial |
$843.51
|
| Rate for Payer: United Healthcare Commercial |
$770.95
|
| Rate for Payer: United Healthcare VA CCN |
$177.63
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
5109924201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$251.92 |
| Rate for Payer: Aetna of VT Commercial |
$251.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.52
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$57.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare VA CCN |
$55.39
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$214.81 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$291.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.57
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare VA CCN |
$218.25
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna of VT Commercial |
$207.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$185.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.40
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.30
|
| Rate for Payer: United Healthcare Commercial |
$207.10
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna of VT Commercial |
$207.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$131.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$185.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.31
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.10
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.10
|
| Rate for Payer: United Healthcare Commercial |
$207.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.10
|
| Rate for Payer: United Healthcare VA CCN |
$98.10
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
5109924201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$204.92 |
| Rate for Payer: Aetna of VT Commercial |
$204.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.52
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$57.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: United Healthcare Commercial |
$185.30
|
| Rate for Payer: United Healthcare VA CCN |
$55.39
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
5109924201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.06
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.60
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.60
|
| Rate for Payer: United Healthcare VA CCN |
$120.60
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$455.90 |
| Rate for Payer: Aetna of VT Commercial |
$455.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.52
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$57.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: United Healthcare Commercial |
$412.25
|
| Rate for Payer: United Healthcare VA CCN |
$55.39
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9609924201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$358.95 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.00
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
|
|
OLIGOCLONAL IMMUNE
|
Facility
|
IP
|
$221.05
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
3008391601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of VT Commercial |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.84
|
| Rate for Payer: Cash Price |
$110.53
|
| Rate for Payer: Cigna Commercial |
$176.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.84
|
| Rate for Payer: Multiplan Commercial |
$205.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.89
|
| Rate for Payer: United Healthcare Commercial |
$210.00
|
|
|
OLIGOCLONAL IMMUNE
|
Facility
|
OP
|
$221.05
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
3008391601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of VT Commercial |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.73
|
| Rate for Payer: Cash Price |
$110.53
|
| Rate for Payer: Cash Price |
$110.53
|
| Rate for Payer: Cigna Commercial |
$176.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.47
|
| Rate for Payer: Multiplan Commercial |
$205.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.47
|
| Rate for Payer: United Healthcare Commercial |
$210.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare VA CCN |
$99.47
|
|
|
OLIGOCLONAL IMMUNE
|
Professional
|
Both
|
$221.05
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
3008391601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$207.79 |
| Rate for Payer: Aetna of VT Commercial |
$207.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.75
|
| Rate for Payer: Cash Price |
$110.53
|
| Rate for Payer: Cash Price |
$110.53
|
| Rate for Payer: Cigna Commercial |
$33.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.01
|
| Rate for Payer: Multiplan Commercial |
$205.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare Commercial |
$42.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare VA CCN |
$27.39
|
|
