|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna of VT Commercial |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.60
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.95
|
| Rate for Payer: United Healthcare Commercial |
$158.65
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna of VT Commercial |
$36.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.40
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$30.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$30.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$35.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.30
|
| Rate for Payer: United Healthcare Commercial |
$36.10
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna of VT Commercial |
$36.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.21
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$30.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$30.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$30.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$35.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$36.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.10
|
| Rate for Payer: United Healthcare VA CCN |
$17.10
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna of VT Commercial |
$156.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.39
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$25.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare Commercial |
$33.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare VA CCN |
$21.48
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$48.35 |
| Rate for Payer: Aetna of VT Commercial |
$35.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.39
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$25.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$35.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare Commercial |
$33.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare VA CCN |
$21.48
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
9609892501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna of VT Commercial |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$100.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.76
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$133.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$158.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.15
|
| Rate for Payer: United Healthcare VA CCN |
$75.15
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
5109892501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare VA CCN |
$58.50
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
5109892501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
|
|
OSTEOPATH MANJ 1-2 REGIONS
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
5109892501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna of VT Commercial |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$25.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare Commercial |
$33.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.48
|
| Rate for Payer: United Healthcare VA CCN |
$21.48
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
IP
|
$358.80
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$265.55 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna of VT Commercial |
$340.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.04
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$333.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.98
|
| Rate for Payer: United Healthcare Commercial |
$340.86
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
OP
|
$358.80
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$158.91 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna of VT Commercial |
$340.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.25
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.46
|
| Rate for Payer: Multiplan Commercial |
$333.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.46
|
| Rate for Payer: United Healthcare Commercial |
$340.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.46
|
| Rate for Payer: United Healthcare VA CCN |
$161.46
|
|
|
OT EVAL LOW COMPLEX 30 MIN
|
Facility
|
IP
|
$346.39
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$256.36 |
| Max. Negotiated Rate |
$329.07 |
| Rate for Payer: Aetna of VT Commercial |
$329.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.11
|
| Rate for Payer: Cash Price |
$173.20
|
| Rate for Payer: Cigna Commercial |
$277.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.11
|
| Rate for Payer: Multiplan Commercial |
$322.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.43
|
| Rate for Payer: United Healthcare Commercial |
$329.07
|
|
|
OT EVAL LOW COMPLEX 30 MIN
|
Facility
|
OP
|
$346.39
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$153.42 |
| Max. Negotiated Rate |
$329.07 |
| Rate for Payer: Aetna of VT Commercial |
$329.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.38
|
| Rate for Payer: Cash Price |
$173.20
|
| Rate for Payer: Cigna Commercial |
$277.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.88
|
| Rate for Payer: Multiplan Commercial |
$322.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.88
|
| Rate for Payer: United Healthcare Commercial |
$329.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.88
|
| Rate for Payer: United Healthcare VA CCN |
$155.88
|
|
|
OT EVAL MOD COMPLEX 45 MIN
|
Facility
|
OP
|
$335.02
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$148.38 |
| Max. Negotiated Rate |
$318.27 |
| Rate for Payer: Aetna of VT Commercial |
$318.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$148.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.34
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cigna Commercial |
$268.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.76
|
| Rate for Payer: Multiplan Commercial |
$311.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.76
|
| Rate for Payer: United Healthcare Commercial |
$318.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.76
|
| Rate for Payer: United Healthcare VA CCN |
$150.76
|
|
|
OT EVAL MOD COMPLEX 45 MIN
|
Facility
|
IP
|
$335.02
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$247.95 |
| Max. Negotiated Rate |
$318.27 |
| Rate for Payer: Aetna of VT Commercial |
$318.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.02
|
| Rate for Payer: Cash Price |
$167.51
|
| Rate for Payer: Cigna Commercial |
$268.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$268.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$268.02
|
| Rate for Payer: Multiplan Commercial |
$311.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.77
|
| Rate for Payer: United Healthcare Commercial |
$318.27
|
|
|
OTHER SOURCE ALBUMIN QUAN EA
|
Facility
|
IP
|
$43.43
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3008204201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.14 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Aetna of VT Commercial |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.74
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.74
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.92
|
| Rate for Payer: United Healthcare Commercial |
$41.26
|
|
|
OTHER SOURCE ALBUMIN QUAN EA
|
Facility
|
OP
|
$43.43
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3008204201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Aetna of VT Commercial |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.53
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.54
|
| Rate for Payer: United Healthcare Commercial |
$41.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare VA CCN |
$19.54
|
|
|
OTHER SOURCE ALBUMIN QUAN EA
|
Professional
|
Both
|
$43.43
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3008204201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna of VT Commercial |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.25
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.67
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare Commercial |
$11.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare VA CCN |
$7.78
|
|
|
OT PHYS PERFRM TEST EA 15 MIN
|
Facility
|
IP
|
$173.71
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
4309775001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of VT Commercial |
$165.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.97
|
| Rate for Payer: Cash Price |
$86.86
|
| Rate for Payer: Cigna Commercial |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.97
|
| Rate for Payer: Multiplan Commercial |
$161.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.65
|
| Rate for Payer: United Healthcare Commercial |
$165.02
|
|
|
OT PHYS PERFRM TEST EA 15 MIN
|
Facility
|
OP
|
$173.71
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
4309775001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna of VT Commercial |
$165.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.10
|
| Rate for Payer: Cash Price |
$86.86
|
| Rate for Payer: Cigna Commercial |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.17
|
| Rate for Payer: Multiplan Commercial |
$161.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.17
|
| Rate for Payer: United Healthcare Commercial |
$165.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.17
|
| Rate for Payer: United Healthcare VA CCN |
$78.17
|
|
|
OT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$259.96
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$246.96 |
| Rate for Payer: Aetna of VT Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.67
|
| Rate for Payer: Cash Price |
$129.98
|
| Rate for Payer: Cigna Commercial |
$207.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.98
|
| Rate for Payer: Multiplan Commercial |
$241.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.98
|
| Rate for Payer: United Healthcare Commercial |
$246.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.98
|
| Rate for Payer: United Healthcare VA CCN |
$116.98
|
|
|
OT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$259.96
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$246.96 |
| Rate for Payer: Aetna of VT Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.97
|
| Rate for Payer: Cash Price |
$129.98
|
| Rate for Payer: Cigna Commercial |
$207.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.97
|
| Rate for Payer: Multiplan Commercial |
$241.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.97
|
| Rate for Payer: United Healthcare Commercial |
$246.96
|
|
|
OVA AND PARASITES SMEARS
|
Facility
|
IP
|
$115.81
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
3008717701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.71 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna of VT Commercial |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.65
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.65
|
| Rate for Payer: Multiplan Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.44
|
| Rate for Payer: United Healthcare Commercial |
$110.02
|
|
|
OVA AND PARASITES SMEARS
|
Professional
|
Both
|
$115.81
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
3008717701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$108.86 |
| Rate for Payer: Aetna of VT Commercial |
$108.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.96
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cigna Commercial |
$10.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.90
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.90
|
| Rate for Payer: United Healthcare VA CCN |
$8.90
|
|
|
OVA AND PARASITES SMEARS
|
Facility
|
OP
|
$115.81
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
3008717701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna of VT Commercial |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.07
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.11
|
| Rate for Payer: Multiplan Commercial |
$107.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.11
|
| Rate for Payer: United Healthcare Commercial |
$110.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.90
|
| Rate for Payer: United Healthcare VA CCN |
$52.11
|
|
