|
TRANSJ CARE MGMT HIGH F2F 7D
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$178.33 |
| Max. Negotiated Rate |
$681.50 |
| Rate for Payer: Aetna of VT Commercial |
$681.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$249.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$205.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.46
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$194.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.94
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare Commercial |
$274.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare VA CCN |
$178.33
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$536.57 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Aetna of VT Commercial |
$688.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$536.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$536.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$616.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$609.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$580.00
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$580.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$580.00
|
| Rate for Payer: Multiplan Commercial |
$674.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$616.25
|
| Rate for Payer: United Healthcare Commercial |
$688.75
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$652.03 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Aetna of VT Commercial |
$836.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$652.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$652.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$740.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.80
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cigna Commercial |
$704.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.80
|
| Rate for Payer: Multiplan Commercial |
$819.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.85
|
| Rate for Payer: United Healthcare Commercial |
$836.95
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
5109949601
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$390.19 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Aetna of VT Commercial |
$836.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$390.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$530.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$713.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$700.39
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cigna Commercial |
$704.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.45
|
| Rate for Payer: Multiplan Commercial |
$819.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.45
|
| Rate for Payer: United Healthcare Commercial |
$836.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.45
|
| Rate for Payer: United Healthcare VA CCN |
$396.45
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
5109949601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.76 |
| Max. Negotiated Rate |
$433.55 |
| 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 Qualified Health Plan |
$183.68
|
| 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 |
$249.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$205.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.46
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$194.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.94
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare Commercial |
$274.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare VA CCN |
$178.33
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
5109949601
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
TRANSJ CARE MGMT HIGH F2F 7D
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
9609949601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$178.33 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna of VT Commercial |
$828.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$789.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$249.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$205.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.46
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cash Price |
$440.50
|
| Rate for Payer: Cigna Commercial |
$194.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$433.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$433.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.94
|
| Rate for Payer: Multiplan Commercial |
$819.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare Commercial |
$274.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.33
|
| Rate for Payer: United Healthcare VA CCN |
$178.33
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.50 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna of VT Commercial |
$528.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$472.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.80
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$472.60
|
| Rate for Payer: United Healthcare Commercial |
$528.20
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$522.64 |
| Rate for Payer: Aetna of VT Commercial |
$522.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.52
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$143.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.81
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$202.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare VA CCN |
$131.32
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$315.34 |
| Max. Negotiated Rate |
$676.40 |
| Rate for Payer: Aetna of VT Commercial |
$676.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$315.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$428.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$605.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$576.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$566.04
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.40
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.40
|
| Rate for Payer: United Healthcare Commercial |
$676.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.40
|
| Rate for Payer: United Healthcare VA CCN |
$320.40
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$526.95 |
| Max. Negotiated Rate |
$676.40 |
| Rate for Payer: Aetna of VT Commercial |
$676.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$526.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$526.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$605.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$598.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$569.60
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.60
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$605.20
|
| Rate for Payer: United Healthcare Commercial |
$676.40
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
5109949501
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$669.28 |
| Rate for Payer: Aetna of VT Commercial |
$669.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.52
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$143.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.81
|
| Rate for Payer: Multiplan Commercial |
$662.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$202.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare VA CCN |
$131.32
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
5109949501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$319.90 |
| 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 Qualified Health Plan |
$135.26
|
| 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 |
$183.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$269.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.52
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$143.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.81
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare Commercial |
$202.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.32
|
| Rate for Payer: United Healthcare VA CCN |
$131.32
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
5109949501
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
TRANSJ CARE MGMT MOD F2F 14D
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
9609949502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna of VT Commercial |
$528.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$334.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$472.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$450.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$442.02
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$472.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.20
|
| Rate for Payer: United Healthcare Commercial |
$528.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.20
|
| Rate for Payer: United Healthcare VA CCN |
$250.20
|
|
|
TRANSPLANT FOREARM TENDON
|
Professional
|
Both
|
$1,607.00
|
|
|
Service Code
|
CPT 25310
|
| Hospital Charge Code |
9822531001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$681.11 |
| Max. Negotiated Rate |
$1,510.58 |
| Rate for Payer: Aetna of VT Commercial |
$1,510.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$701.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$953.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,100.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,100.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$783.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,100.53
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,124.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,128.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,128.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$681.11
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$967.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$681.11
|
| Rate for Payer: United Healthcare Commercial |
$1,047.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$681.11
|
| Rate for Payer: United Healthcare VA CCN |
$681.11
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 25310
|
| Hospital Charge Code |
9822531001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,189.34 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,526.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,189.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,189.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,365.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,349.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.60
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,285.60
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,365.95
|
| Rate for Payer: United Healthcare Commercial |
$1,526.65
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 25310
|
| Hospital Charge Code |
9822531001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$711.74 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,526.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$711.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,439.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$967.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,365.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,301.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$723.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,277.57
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,285.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,285.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$723.15
|
| Rate for Payer: Multiplan Commercial |
$1,494.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,365.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$723.15
|
| Rate for Payer: United Healthcare Commercial |
$1,526.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$723.15
|
| Rate for Payer: United Healthcare VA CCN |
$723.15
|
|
|
TRAY IRRIG PISTON
|
Facility
|
IP
|
$18.19
|
|
| Hospital Charge Code |
2720057071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna of VT Commercial |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.55
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cigna Commercial |
$14.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$16.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$17.28
|
|
|
TRAY IRRIG PISTON
|
Facility
|
OP
|
$18.19
|
|
| Hospital Charge Code |
2720057071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna of VT Commercial |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.46
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cigna Commercial |
$14.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$16.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.19
|
| Rate for Payer: United Healthcare Commercial |
$17.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.19
|
| Rate for Payer: United Healthcare VA CCN |
$8.19
|
|
|
TRAY PICC DOUBLE LUMEN 5FR
|
Facility
|
IP
|
$267.33
|
|
| Hospital Charge Code |
2720075461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$253.96 |
| Rate for Payer: Aetna of VT Commercial |
$253.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.86
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cigna Commercial |
$213.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$248.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.23
|
| Rate for Payer: United Healthcare Commercial |
$253.96
|
|
|
TRAY PICC DOUBLE LUMEN 5FR
|
Facility
|
OP
|
$267.33
|
|
| Hospital Charge Code |
2720075461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$253.96 |
| Rate for Payer: Aetna of VT Commercial |
$253.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$227.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.53
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cigna Commercial |
$213.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.30
|
| Rate for Payer: Multiplan Commercial |
$248.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$227.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.30
|
| Rate for Payer: United Healthcare Commercial |
$253.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.30
|
| Rate for Payer: United Healthcare VA CCN |
$120.30
|
|
|
TRAY SUTURE
|
Facility
|
IP
|
$22.71
|
|
| Hospital Charge Code |
2720058161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna of VT Commercial |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.17
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Cigna Commercial |
$18.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.17
|
| Rate for Payer: Multiplan Commercial |
$21.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.30
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
|
