|
PROGESTERONE RECEPTOR
|
Facility
|
IP
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$323.70 |
| 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 |
$323.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.90
|
| 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: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.77
|
| Rate for Payer: United Healthcare Commercial |
$415.51
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
9879941801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.35
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$40.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.15
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$39.16
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
9879941801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
9879941801
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
5109941801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 99418
|
| Hospital Charge Code |
5109941801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
PROLNG IP/OBS E/M EA 15 MIN
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
5109941801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.44
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.08
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare VA CCN |
$29.61
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna of VT Commercial |
$143.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.05
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.95
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.95
|
| Rate for Payer: United Healthcare Commercial |
$143.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.95
|
| Rate for Payer: United Healthcare VA CCN |
$67.95
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.17
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare VA CCN |
$39.15
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
5109941701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of VT Commercial |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.40
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$81.78 |
| Rate for Payer: Aetna of VT Commercial |
$81.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.44
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.08
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare VA CCN |
$29.61
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna of VT Commercial |
$143.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.80
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.80
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.35
|
| Rate for Payer: United Healthcare Commercial |
$143.45
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.60
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
5109941701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of VT Commercial |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.88
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.80
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.80
|
| Rate for Payer: United Healthcare VA CCN |
$28.80
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
5109941701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Aetna of VT Commercial |
$60.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.44
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.08
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare VA CCN |
$29.61
|
|
|
PROLNG OP E/M EACH 15 MIN
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
9609941701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$141.94 |
| Rate for Payer: Aetna of VT Commercial |
$141.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.44
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.08
|
| Rate for Payer: Multiplan Commercial |
$140.43
|
| Rate for Payer: United Healthcare Commercial |
$128.35
|
| Rate for Payer: United Healthcare VA CCN |
$29.61
|
|
|
PROLNG SVC I/P/OBS EA ADDL
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 99357
|
| Hospital Charge Code |
9879935701
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$233.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.80
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
|
|
PROLNG SVC I/P/OBS EA ADDL
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 99357
|
| Hospital Charge Code |
9879935701
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna of VT Commercial |
$300.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.22
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare Commercial |
$300.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.20
|
| Rate for Payer: United Healthcare VA CCN |
$142.20
|
|
|
PROLNG SVC I/P/OBS EA ADDL
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 99357
|
| Hospital Charge Code |
9879935701
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$297.04 |
| Rate for Payer: Aetna of VT Commercial |
$297.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: United Healthcare Commercial |
$268.60
|
| Rate for Payer: United Healthcare VA CCN |
$126.40
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9609935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9609935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9609935502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
| Rate for Payer: United Healthcare VA CCN |
$57.60
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
5109935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$63.92 |
| Rate for Payer: Aetna of VT Commercial |
$63.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.92
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$63.24
|
| Rate for Payer: United Healthcare Commercial |
$57.80
|
| Rate for Payer: United Healthcare VA CCN |
$27.20
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
5109935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna of VT Commercial |
$64.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.06
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$63.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.60
|
| Rate for Payer: United Healthcare VA CCN |
$30.60
|
|
|
PROLNG SVC O/P EA ADDL 30
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 99355
|
| Hospital Charge Code |
9609935501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna of VT Commercial |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.80
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.35
|
| Rate for Payer: United Healthcare Commercial |
$200.45
|
|
