|
ORAL FUNCTION THERAPY
|
Facility
|
IP
|
$170.61
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
4409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.49
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
|
|
ORAL FUNCTION THERAPY
|
Facility
|
OP
|
$170.61
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
4409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.63
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.77
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare VA CCN |
$76.77
|
|
|
ORGANIC ACID 1 QUANTITATIVE
|
Professional
|
Both
|
$175.78
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
3008392101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$165.23 |
| Rate for Payer: Aetna of VT Commercial |
$165.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.25
|
| Rate for Payer: Cash Price |
$87.89
|
| Rate for Payer: Cash Price |
$87.89
|
| Rate for Payer: Cigna Commercial |
$25.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.91
|
| Rate for Payer: Multiplan Commercial |
$163.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.21
|
| Rate for Payer: United Healthcare Commercial |
$32.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.21
|
| Rate for Payer: United Healthcare VA CCN |
$21.21
|
|
|
ORGANIC ACID 1 QUANTITATIVE
|
Facility
|
OP
|
$175.78
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
3008392101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$166.99 |
| Rate for Payer: Aetna of VT Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.75
|
| Rate for Payer: Cash Price |
$87.89
|
| Rate for Payer: Cash Price |
$87.89
|
| Rate for Payer: Cigna Commercial |
$140.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$163.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$166.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.21
|
| Rate for Payer: United Healthcare VA CCN |
$79.10
|
|
|
ORGANIC ACID 1 QUANTITATIVE
|
Facility
|
IP
|
$175.78
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
3008392101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.09 |
| Max. Negotiated Rate |
$166.99 |
| Rate for Payer: Aetna of VT Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.62
|
| Rate for Payer: Cash Price |
$87.89
|
| Rate for Payer: Cigna Commercial |
$140.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.62
|
| Rate for Payer: Multiplan Commercial |
$163.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.41
|
| Rate for Payer: United Healthcare Commercial |
$166.99
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
9829776301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.40
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 97763 GP
|
| Hospital Charge Code |
4209776301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$68.56 |
| Rate for Payer: Aetna of VT Commercial |
$68.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.38
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.48
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.48
|
| Rate for Payer: United Healthcare VA CCN |
$32.48
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 97763 GP
|
| Hospital Charge Code |
4209776301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$68.56 |
| Rate for Payer: Aetna of VT Commercial |
$68.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.74
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.74
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.34
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
9829776301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna of VT Commercial |
$140.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.66
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.60
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare Commercial |
$140.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.60
|
| Rate for Payer: United Healthcare VA CCN |
$66.60
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
4309776301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$68.56 |
| Rate for Payer: Aetna of VT Commercial |
$68.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.38
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.48
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.48
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.48
|
| Rate for Payer: United Healthcare VA CCN |
$32.48
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
4309776301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$68.56 |
| Rate for Payer: Aetna of VT Commercial |
$68.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.74
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.74
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.34
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
|
|
ORTHC/PROSTC MGMT SBSQ ENC
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
9829776301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$139.12 |
| Rate for Payer: Aetna of VT Commercial |
$139.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.61
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$61.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.74
|
| Rate for Payer: Multiplan Commercial |
$137.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.74
|
| Rate for Payer: United Healthcare Commercial |
$76.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.74
|
| Rate for Payer: United Healthcare VA CCN |
$49.74
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
IP
|
$155.58
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
4309776001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna of VT Commercial |
$147.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.46
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Multiplan Commercial |
$144.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$147.80
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
IP
|
$155.58
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
4209776001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna of VT Commercial |
$147.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.46
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Multiplan Commercial |
$144.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$147.80
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
OP
|
$155.58
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
4209776001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.91 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna of VT Commercial |
$147.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.69
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.01
|
| Rate for Payer: Multiplan Commercial |
$144.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.01
|
| Rate for Payer: United Healthcare Commercial |
$147.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.01
|
| Rate for Payer: United Healthcare VA CCN |
$70.01
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
9829776001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna of VT Commercial |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.60
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: United Healthcare Commercial |
$49.40
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
9829776001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna of VT Commercial |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.89
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$56.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.57
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.57
|
| Rate for Payer: United Healthcare Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.57
|
| Rate for Payer: United Healthcare VA CCN |
$45.57
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
OP
|
$155.58
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
4309776001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.91 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna of VT Commercial |
$147.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.69
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cigna Commercial |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.01
|
| Rate for Payer: Multiplan Commercial |
$144.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.01
|
| Rate for Payer: United Healthcare Commercial |
$147.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.01
|
| Rate for Payer: United Healthcare VA CCN |
$70.01
|
|
|
ORTHOTIC MGMT&TRAING 1ST ENC
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
9829776001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna of VT Commercial |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.34
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$49.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.40
|
| Rate for Payer: United Healthcare VA CCN |
$23.40
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
OP
|
$166.11
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
636J732401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna of VT Commercial |
$157.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.06
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cigna Commercial |
$132.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$154.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.75
|
| Rate for Payer: United Healthcare Commercial |
$157.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.75
|
| Rate for Payer: United Healthcare VA CCN |
$74.75
|
|
|
ORTHOVISC INJ PER DOSE
|
Facility
|
IP
|
$166.11
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
636J732401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.94 |
| Max. Negotiated Rate |
$157.80 |
| Rate for Payer: Aetna of VT Commercial |
$157.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.89
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cigna Commercial |
$132.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.89
|
| Rate for Payer: Multiplan Commercial |
$154.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.19
|
| Rate for Payer: United Healthcare Commercial |
$157.80
|
|
|
ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$166.11
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
636J732401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.14 |
| Max. Negotiated Rate |
$344.58 |
| Rate for Payer: Aetna of VT Commercial |
$156.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.72
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Cash Price |
$83.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.30
|
| Rate for Payer: Multiplan Commercial |
$154.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.54
|
| Rate for Payer: United Healthcare Commercial |
$176.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.54
|
| Rate for Payer: United Healthcare VA CCN |
$114.54
|
|
|
OSTECTOMY CALCANEUS
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
9822811801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,297.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$605.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$822.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,106.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$614.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,085.97
|
| Rate for Payer: Cash Price |
$683.00
|
| Rate for Payer: Cigna Commercial |
$1,092.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,092.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,092.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$614.70
|
| Rate for Payer: Multiplan Commercial |
$1,270.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,161.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$614.70
|
| Rate for Payer: United Healthcare Commercial |
$1,297.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$614.70
|
| Rate for Payer: United Healthcare VA CCN |
$614.70
|
|
|
OSTECTOMY CALCANEUS
|
Professional
|
Both
|
$1,366.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
9822811801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$405.71 |
| Max. Negotiated Rate |
$1,284.04 |
| Rate for Payer: Aetna of VT Commercial |
$1,284.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$417.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$567.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$863.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$466.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$863.12
|
| Rate for Payer: Cash Price |
$683.00
|
| Rate for Payer: Cash Price |
$683.00
|
| Rate for Payer: Cigna Commercial |
$765.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$938.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$938.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$574.66
|
| Rate for Payer: Multiplan Commercial |
$1,270.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.71
|
| Rate for Payer: United Healthcare Commercial |
$624.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.71
|
| Rate for Payer: United Healthcare VA CCN |
$405.71
|
|
|
OSTECTOMY CALCANEUS
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
9822811801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,010.98 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,297.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,010.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,147.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,092.80
|
| Rate for Payer: Cash Price |
$683.00
|
| Rate for Payer: Cigna Commercial |
$1,092.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,092.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,092.80
|
| Rate for Payer: Multiplan Commercial |
$1,270.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,161.10
|
| Rate for Payer: United Healthcare Commercial |
$1,297.70
|
|
