|
PERQ DEVICE BREAST EA IMAG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 19282 26
|
| Hospital Charge Code |
9721928201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$238.39
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$83.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$160.56
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: United Healthcare Commercial |
$361.25
|
| Rate for Payer: United Healthcare VA CCN |
$170.00
|
|
|
PERQ DEVICE BREAST EA IMAG
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 19282 26
|
| Hospital Charge Code |
9721928201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
PFIZER SARSCV2 VAC <12YRS OLD
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
6369131901
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
PFIZER SARSCV2 VAC <12YRS OLD
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
6369131901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PFIZER SARSCV2 VAC <12YRS OLD
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
6369131901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.78
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.80
|
| Rate for Payer: United Healthcare Commercial |
$145.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.80
|
| Rate for Payer: United Healthcare VA CCN |
$94.80
|
|
|
PFIZER VAC 3MCG TRS-S 6 MO<5YR
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
6369131801
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$180.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.55
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
PFIZER VAC 3MCG TRS-S 6 MO<5YR
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
6369131801
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$180.26 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
PFIZER VAC 3MCG TRS-S 6 MO<5YR
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
6369131801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PHLEBOTOMY THERAPEUTC SEP PROC
|
Facility
|
IP
|
$276.72
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
9409919501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$262.88 |
| Rate for Payer: Aetna of VT Commercial |
$262.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$204.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$204.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.38
|
| Rate for Payer: Cash Price |
$138.36
|
| Rate for Payer: Cigna Commercial |
$221.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.38
|
| Rate for Payer: Multiplan Commercial |
$257.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.21
|
| Rate for Payer: United Healthcare Commercial |
$262.88
|
|
|
PHLEBOTOMY THERAPEUTC SEP PROC
|
Facility
|
OP
|
$276.72
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
9409919501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$122.56 |
| Max. Negotiated Rate |
$262.88 |
| Rate for Payer: Aetna of VT Commercial |
$262.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.99
|
| Rate for Payer: Cash Price |
$138.36
|
| Rate for Payer: Cigna Commercial |
$221.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.52
|
| Rate for Payer: Multiplan Commercial |
$257.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.52
|
| Rate for Payer: United Healthcare Commercial |
$262.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.52
|
| Rate for Payer: United Healthcare VA CCN |
$124.52
|
|
|
PHONE E/M PHYS/QHP 11-20 MIN
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
9839944201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
PHONE E/M PHYS/QHP 11-20 MIN
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
9839944201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
PHONE E/M PHYS/QHP 11-20 MIN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
9839944201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
PHONE E/M PHYS/QHP 21-30 MIN
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9609944301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.52 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.97
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.70
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.70
|
| Rate for Payer: United Healthcare VA CCN |
$74.70
|
|
|
PHONE E/M PHYS/QHP 21-30 MIN
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9609944301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna of VT Commercial |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.26
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$99.29
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: United Healthcare Commercial |
$141.10
|
| Rate for Payer: United Healthcare VA CCN |
$66.40
|
|
|
PHONE E/M PHYS/QHP 21-30 MIN
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
9609944301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna of VT Commercial |
$157.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.80
|
| Rate for Payer: Cash Price |
$83.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.80
|
| Rate for Payer: Multiplan Commercial |
$154.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.10
|
| Rate for Payer: United Healthcare Commercial |
$157.70
|
|
|
PHONE E/M PHYS/QHP 5-10 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
9609944101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.98
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$35.74
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$21.60
|
|
|
PHONE E/M PHYS/QHP 5-10 MIN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
9609944101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
PHONE E/M PHYS/QHP 5-10 MIN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
9609944101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
IP
|
$68.04
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
9489462501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna of VT Commercial |
$64.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.43
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$54.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.43
|
| Rate for Payer: Multiplan Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.83
|
| Rate for Payer: United Healthcare Commercial |
$64.64
|
|
|
PHY/QHP OP PULM RHB W/O MNTR
|
Facility
|
OP
|
$68.04
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
9489462501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna of VT Commercial |
$64.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.09
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$54.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.62
|
| Rate for Payer: United Healthcare Commercial |
$64.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.62
|
| Rate for Payer: United Healthcare VA CCN |
$30.62
|
|
|
PHYSICIAN STANDBY SERVICES
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 99360
|
| Hospital Charge Code |
9829936001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$119.58 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of VT Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.65
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare VA CCN |
$121.50
|
|
|
PHYSICIAN STANDBY SERVICES
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 99360
|
| Hospital Charge Code |
9829936001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$199.83 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of VT Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
PHYS PERFRM TEST EA 15 MIN
|
Facility
|
IP
|
$173.71
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
4209775001
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PHYS PERFRM TEST EA 15 MIN
|
Facility
|
OP
|
$173.71
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
4209775001
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
