|
ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
9879946401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$198.35 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna of VT Commercial |
$254.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.40
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$249.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.80
|
| Rate for Payer: United Healthcare Commercial |
$254.60
|
|
|
AUDIO-ONLY EST 30 MIN
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 98014
|
| Hospital Charge Code |
9609801401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$169.44 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.44
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$85.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.84
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: United Healthcare Commercial |
$132.60
|
| Rate for Payer: United Healthcare VA CCN |
$62.40
|
|
|
AUDIO-ONLY EST 30 MIN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 98014
|
| Hospital Charge Code |
9609801401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
AUDIO-ONLY EST 30 MIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 98014
|
| Hospital Charge Code |
9609801401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
AUDIO-ONLY EST SF 10 MIN
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 98012
|
| Hospital Charge Code |
9609801201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
AUDIO-ONLY EST SF 10 MIN
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 98012
|
| Hospital Charge Code |
9609801201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
AUDIO-ONLY EST SF 10 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 98012
|
| Hospital Charge Code |
9609801201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.69
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$31.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.55
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$21.60
|
|
|
AUDIO-ONLY NEW HIGH 60 MIN
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
9609801101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.91 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna of VT Commercial |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.60
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.20
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
|
|
AUDIO-ONLY NEW HIGH 60 MIN
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
9609801101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$308.46 |
| Rate for Payer: Aetna of VT Commercial |
$293.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$155.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.35
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare VA CCN |
$124.80
|
|
|
AUDIO-ONLY NEW HIGH 60 MIN
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
9609801101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna of VT Commercial |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$252.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.04
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.40
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.40
|
| Rate for Payer: United Healthcare VA CCN |
$140.40
|
|
|
AUDIO-ONLY NEW LOW 30 MIN
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
9609800901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$168.55 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.55
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$75.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.85
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: United Healthcare Commercial |
$132.60
|
| Rate for Payer: United Healthcare VA CCN |
$62.40
|
|
|
AUDIO-ONLY NEW LOW 30 MIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
9609800901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
AUDIO-ONLY NEW LOW 30 MIN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
9609800901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
AUDIO-ONLY NEW MOD 45 MIN
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
9609801001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$243.32 |
| Rate for Payer: Aetna of VT Commercial |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.32
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$118.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$193.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$193.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.19
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$178.50
|
| Rate for Payer: United Healthcare VA CCN |
$84.00
|
|
|
AUDIO-ONLY NEW MOD 45 MIN
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
9609801001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.01 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna of VT Commercial |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.95
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.50
|
| Rate for Payer: United Healthcare VA CCN |
$94.50
|
|
|
AUDIO-ONLY NEW MOD 45 MIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
9609801001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna of VT Commercial |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$155.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$155.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
|
|
AUDIO-ONLY NEW SF 15 MIN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
9609800801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
AUDIO-ONLY NEW SF 15 MIN
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
9609800801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$43.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$75.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$75.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.49
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
AUDIO-ONLY NEW SF 15 MIN
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
9609800801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
AUDIO-VIDEO EST HIGH 40 MIN
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 98007
|
| Hospital Charge Code |
9609800701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$135.44 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.40
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
|
|
AUDIO-VIDEO EST HIGH 40 MIN
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
CPT 98007
|
| Hospital Charge Code |
9609800701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna of VT Commercial |
$172.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.30
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$126.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.86
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare VA CCN |
$73.20
|
|
|
AUDIO-VIDEO EST HIGH 40 MIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 98007
|
| Hospital Charge Code |
9609800701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.49
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare VA CCN |
$82.35
|
|
|
AUDIO-VIDEO EST MOD 30 MIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 98006
|
| Hospital Charge Code |
9609800601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
AUDIO-VIDEO EST MOD 30 MIN
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 98006
|
| Hospital Charge Code |
9609800601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$169.44 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.44
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$93.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.04
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: United Healthcare Commercial |
$132.60
|
| Rate for Payer: United Healthcare VA CCN |
$62.40
|
|
|
AUDIO-VIDEO EST MOD 30 MIN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 98006
|
| Hospital Charge Code |
9609800601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
