|
PREV VISIT NEW AGE 40-64
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
5109938601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
PREV VISIT NEW AGE 40-64
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
9609938601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.74 |
| Max. Negotiated Rate |
$483.16 |
| Rate for Payer: Aetna of VT Commercial |
$483.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$460.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$460.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.10
|
| Rate for Payer: Cash Price |
$257.00
|
| Rate for Payer: Cash Price |
$257.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.45
|
| Rate for Payer: Multiplan Commercial |
$478.02
|
| Rate for Payer: United Healthcare Commercial |
$436.90
|
| Rate for Payer: United Healthcare VA CCN |
$111.74
|
|
|
PREV VISIT NEW AGE 40-64
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
9609938602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$253.11 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna of VT Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$253.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$253.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$273.60
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$273.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$318.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.70
|
| Rate for Payer: United Healthcare Commercial |
$324.90
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$245.71 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna of VT Commercial |
$315.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$282.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.60
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.20
|
| Rate for Payer: United Healthcare Commercial |
$315.40
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna of VT Commercial |
$315.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$282.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.94
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$149.40
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.40
|
| Rate for Payer: United Healthcare Commercial |
$315.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.40
|
| Rate for Payer: United Healthcare VA CCN |
$149.40
|
|
|
PREV VISIT NEW AGE 5-11
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$312.08 |
| Rate for Payer: Aetna of VT Commercial |
$312.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$297.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.01
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$84.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.52
|
| Rate for Payer: Multiplan Commercial |
$308.76
|
| Rate for Payer: United Healthcare Commercial |
$282.20
|
| Rate for Payer: United Healthcare VA CCN |
$82.13
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
5109938301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$475.14 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna of VT Commercial |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$539.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$513.60
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.60
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.70
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
5109938301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.34 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna of VT Commercial |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$284.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$386.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$520.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$510.39
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.90
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.90
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.90
|
| Rate for Payer: United Healthcare VA CCN |
$288.90
|
|
|
PREV VISIT NEW AGE 5-11
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
5109938301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$603.48 |
| Rate for Payer: Aetna of VT Commercial |
$603.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$575.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.01
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$84.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.52
|
| Rate for Payer: Multiplan Commercial |
$597.06
|
| Rate for Payer: United Healthcare Commercial |
$545.70
|
| Rate for Payer: United Healthcare VA CCN |
$82.13
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$256.81 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Aetna of VT Commercial |
$329.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.60
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.95
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
|
|
PREV VISIT NEW AGE 5-11
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Aetna of VT Commercial |
$329.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.87
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.15
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.15
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.15
|
| Rate for Payer: United Healthcare VA CCN |
$156.15
|
|
|
PREV VISIT NEW AGE 5-11
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
9609938301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$326.18 |
| Rate for Payer: Aetna of VT Commercial |
$326.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.01
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$84.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.52
|
| Rate for Payer: Multiplan Commercial |
$322.71
|
| Rate for Payer: United Healthcare Commercial |
$294.95
|
| Rate for Payer: United Healthcare VA CCN |
$82.13
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
5109328301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.78 |
| Max. Negotiated Rate |
$215.06 |
| Rate for Payer: Aetna of VT Commercial |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.25
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$215.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.32
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare Commercial |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare VA CCN |
$92.32
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$250.15 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.40
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.71
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare VA CCN |
$152.10
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.32 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of VT Commercial |
$317.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.25
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$215.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.32
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare Commercial |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare VA CCN |
$92.32
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
9609328302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.32 |
| Max. Negotiated Rate |
$243.46 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.25
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$215.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.32
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare Commercial |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.32
|
| Rate for Payer: United Healthcare VA CCN |
$92.32
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
5109328301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.20
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
|
|
PRGRMG EVAL IMPLANTABLE DFB
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
5109328301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.80
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare VA CCN |
$35.55
|
|
|
PROCALCITONIN (PCT)
|
Facility
|
OP
|
$208.87
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
3008414501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$198.43 |
| Rate for Payer: Aetna of VT Commercial |
$198.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.05
|
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Cigna Commercial |
$167.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.99
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.99
|
| Rate for Payer: United Healthcare Commercial |
$198.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare VA CCN |
$93.99
|
|
|
PROCALCITONIN (PCT)
|
Facility
|
IP
|
$208.87
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
3008414501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$198.43 |
| Rate for Payer: Aetna of VT Commercial |
$198.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.10
|
| Rate for Payer: Cash Price |
$104.44
|
| Rate for Payer: Cigna Commercial |
$167.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.10
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.54
|
| Rate for Payer: United Healthcare Commercial |
$198.43
|
|
|
PROGESTERONE RECEPTOR
|
Facility
|
OP
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$415.51 |
| Rate for Payer: Aetna of VT Commercial |
$415.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.72
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna Commercial |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.82
|
| Rate for Payer: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.82
|
| Rate for Payer: United Healthcare Commercial |
$415.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare VA CCN |
$196.82
|
|
|
PROGESTERONE RECEPTOR
|
Professional
|
Both
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$411.14 |
| Rate for Payer: Aetna of VT Commercial |
$411.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.93
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna Commercial |
$154.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.56
|
| Rate for Payer: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare Commercial |
$176.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare VA CCN |
$114.55
|
|
