|
PRP I/HERN INIT BLOCK >5 YR
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
9824950701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,400.27 |
| Max. Negotiated Rate |
$1,797.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,797.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,400.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,400.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,608.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,589.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,513.60
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,513.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,513.60
|
| Rate for Payer: Multiplan Commercial |
$1,759.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,608.20
|
| Rate for Payer: United Healthcare Commercial |
$1,797.40
|
|
|
PRP I/HERN INIT REDUC >5 YR
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
9824950501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$575.33 |
| Max. Negotiated Rate |
$1,234.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,234.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,163.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$575.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,163.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$782.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,052.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$584.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,032.70
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cigna Commercial |
$1,039.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,039.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,039.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$584.55
|
| Rate for Payer: Multiplan Commercial |
$1,208.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,104.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$584.55
|
| Rate for Payer: United Healthcare Commercial |
$1,234.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$584.55
|
| Rate for Payer: United Healthcare VA CCN |
$584.55
|
|
|
PRP I/HERN INIT REDUC >5 YR
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
9824950501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$483.22 |
| Max. Negotiated Rate |
$1,221.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,221.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,163.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,163.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$676.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$790.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$790.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$555.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$790.59
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cigna Commercial |
$881.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$819.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$819.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$483.22
|
| Rate for Payer: Multiplan Commercial |
$1,208.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$686.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$483.22
|
| Rate for Payer: United Healthcare Commercial |
$743.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.22
|
| Rate for Payer: United Healthcare VA CCN |
$483.22
|
|
|
PRP I/HERN INIT REDUC >5 YR
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
9824950501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$961.39 |
| Max. Negotiated Rate |
$1,234.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,234.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$961.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$961.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,091.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,039.20
|
| Rate for Payer: Cash Price |
$649.50
|
| Rate for Payer: Cigna Commercial |
$1,039.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,039.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,039.20
|
| Rate for Payer: Multiplan Commercial |
$1,208.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,104.15
|
| Rate for Payer: United Healthcare Commercial |
$1,234.05
|
|
|
PRQ SKEL FIXJ METAR FX W/MANJ
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
9822847601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$768.96 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.20
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
|
|
PRQ SKEL FIXJ METAR FX W/MANJ
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
9822847601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$460.17 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$841.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.00
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.55
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare VA CCN |
$467.55
|
|
|
PRQ SKEL FIXJ METAR FX W/MANJ
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
9822847601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$378.63 |
| Max. Negotiated Rate |
$976.66 |
| Rate for Payer: Aetna of VT Commercial |
$976.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$389.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$530.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$611.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$611.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$435.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$611.73
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$712.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$619.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$619.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$378.63
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$537.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$378.63
|
| Rate for Payer: United Healthcare Commercial |
$582.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.63
|
| Rate for Payer: United Healthcare VA CCN |
$378.63
|
|
|
PSA TOTAL SCREENING MEDICARE
|
Facility
|
IP
|
$159.24
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
3008415302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.39
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
|
|
PSA TOTAL SCREENING MEDICARE
|
Facility
|
OP
|
$159.24
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
3008415302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.60
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.31
|
| Rate for Payer: United Healthcare VA CCN |
$71.66
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
OP
|
$316.61
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$140.23 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.70
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.47
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare VA CCN |
$142.47
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
IP
|
$316.61
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.29
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.12
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
IP
|
$316.61
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.29
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.12
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
OP
|
$316.61
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$140.23 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.70
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.47
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare VA CCN |
$142.47
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
IP
|
$316.61
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.29
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$269.12
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
OP
|
$316.61
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$140.23 |
| Max. Negotiated Rate |
$300.78 |
| Rate for Payer: Aetna of VT Commercial |
$300.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.70
|
| Rate for Payer: Cash Price |
$158.30
|
| Rate for Payer: Cigna Commercial |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$253.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$253.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.47
|
| Rate for Payer: Multiplan Commercial |
$294.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare Commercial |
$300.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.47
|
| Rate for Payer: United Healthcare VA CCN |
$142.47
|
|
|
PT RE-EVAL EST PLAN CARE 20MIN
|
Facility
|
IP
|
$225.41
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$166.83 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Aetna of VT Commercial |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.33
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cigna Commercial |
$180.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.33
|
| Rate for Payer: Multiplan Commercial |
$209.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.60
|
| Rate for Payer: United Healthcare Commercial |
$214.14
|
|
|
PT RE-EVAL EST PLAN CARE 20MIN
|
Facility
|
OP
|
$225.41
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$99.83 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Aetna of VT Commercial |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.20
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cigna Commercial |
$180.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.43
|
| Rate for Payer: Multiplan Commercial |
$209.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.43
|
| Rate for Payer: United Healthcare Commercial |
$214.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.43
|
| Rate for Payer: United Healthcare VA CCN |
$101.43
|
|
|
PT WHEELCHAIR MGMT EA 15 MIN
|
Facility
|
IP
|
$173.71
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
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
|
|
|
PT WHEELCHAIR MGMT EA 15 MIN
|
Facility
|
OP
|
$173.71
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
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
|
|
|
PULM FUNCTION TEST BY GAS
|
Facility
|
IP
|
$451.86
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$334.42 |
| Max. Negotiated Rate |
$429.27 |
| Rate for Payer: Aetna of VT Commercial |
$429.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.49
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cigna Commercial |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$361.49
|
| Rate for Payer: Multiplan Commercial |
$420.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.08
|
| Rate for Payer: United Healthcare Commercial |
$429.27
|
|
|
PULM FUNCTION TEST BY GAS
|
Facility
|
OP
|
$451.86
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$200.13 |
| Max. Negotiated Rate |
$429.27 |
| Rate for Payer: Aetna of VT Commercial |
$429.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$200.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$272.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$366.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$203.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$359.23
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cigna Commercial |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$361.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$203.34
|
| Rate for Payer: Multiplan Commercial |
$420.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$203.34
|
| Rate for Payer: United Healthcare Commercial |
$429.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.34
|
| Rate for Payer: United Healthcare VA CCN |
$203.34
|
|
|
PULM FUNCTION TEST BY GAS
|
Professional
|
Both
|
$451.86
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$424.75 |
| Rate for Payer: Aetna of VT Commercial |
$424.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.13
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cigna Commercial |
$64.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.12
|
| Rate for Payer: Multiplan Commercial |
$420.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.11
|
| Rate for Payer: United Healthcare Commercial |
$66.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.11
|
| Rate for Payer: United Healthcare VA CCN |
$43.11
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Professional
|
Both
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
9769472601
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$329.50 |
| Rate for Payer: Aetna of VT Commercial |
$329.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.10
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$80.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.20
|
| Rate for Payer: United Healthcare Commercial |
$83.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.20
|
| Rate for Payer: United Healthcare VA CCN |
$54.20
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
OP
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
9769472601
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of VT Commercial |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$155.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$211.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$297.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.67
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.74
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.74
|
| Rate for Payer: United Healthcare Commercial |
$333.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.74
|
| Rate for Payer: United Healthcare VA CCN |
$157.74
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Professional
|
Both
|
$350.53
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
4609472601
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$329.50 |
| Rate for Payer: Aetna of VT Commercial |
$329.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.10
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cash Price |
$175.26
|
| Rate for Payer: Cigna Commercial |
$80.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$325.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.20
|
| Rate for Payer: United Healthcare Commercial |
$83.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.20
|
| Rate for Payer: United Healthcare VA CCN |
$54.20
|
|
