|
TYMPANOMETRY & REFLEX THRESH
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$44.18 |
| Rate for Payer: Aetna of VT Commercial |
$44.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.97
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$23.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$43.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare VA CCN |
$20.80
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$74.45
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
4719255001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.19
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.50
|
| Rate for Payer: United Healthcare VA CCN |
$33.50
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna of VT Commercial |
$114.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.19
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$96.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.45
|
| Rate for Payer: Multiplan Commercial |
$112.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.45
|
| Rate for Payer: United Healthcare Commercial |
$114.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.45
|
| Rate for Payer: United Healthcare VA CCN |
$54.45
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$113.74 |
| Rate for Payer: Aetna of VT Commercial |
$113.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.97
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$23.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$112.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare VA CCN |
$20.80
|
|
|
TYPHOID VACCINE IM
|
Professional
|
Both
|
$193.38
|
|
|
Service Code
|
CPT 90691
|
| Hospital Charge Code |
6369069101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$403.07 |
| Rate for Payer: Aetna of VT Commercial |
$181.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$403.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$403.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.52
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Cash Price |
$96.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.68
|
| Rate for Payer: Multiplan Commercial |
$179.84
|
| Rate for Payer: United Healthcare Commercial |
$164.37
|
| Rate for Payer: United Healthcare VA CCN |
$164.00
|
|
|
ULTRASOUND THERAPY
|
Facility
|
IP
|
$105.57
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
4309703501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$100.29 |
| Rate for Payer: Aetna of VT Commercial |
$100.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.46
|
| Rate for Payer: Cash Price |
$52.78
|
| Rate for Payer: Cigna Commercial |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.46
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$100.29
|
|
|
ULTRASOUND THERAPY
|
Facility
|
OP
|
$105.57
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4209703501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$100.29 |
| Rate for Payer: Aetna of VT Commercial |
$100.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.93
|
| Rate for Payer: Cash Price |
$52.78
|
| Rate for Payer: Cigna Commercial |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.51
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.51
|
| Rate for Payer: United Healthcare Commercial |
$100.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.51
|
| Rate for Payer: United Healthcare VA CCN |
$47.51
|
|
|
ULTRASOUND THERAPY
|
Facility
|
IP
|
$105.57
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4209703501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$100.29 |
| Rate for Payer: Aetna of VT Commercial |
$100.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.46
|
| Rate for Payer: Cash Price |
$52.78
|
| Rate for Payer: Cigna Commercial |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.46
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.73
|
| Rate for Payer: United Healthcare Commercial |
$100.29
|
|
|
ULTRASOUND THERAPY
|
Facility
|
OP
|
$105.57
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
4309703501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$100.29 |
| Rate for Payer: Aetna of VT Commercial |
$100.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.93
|
| Rate for Payer: Cash Price |
$52.78
|
| Rate for Payer: Cigna Commercial |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.51
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.51
|
| Rate for Payer: United Healthcare Commercial |
$100.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.51
|
| Rate for Payer: United Healthcare VA CCN |
$47.51
|
|
|
ULTRAVIOLET LIGHT THERAPY
|
Facility
|
OP
|
$96.16
|
|
|
Service Code
|
CPT 96900
|
| Hospital Charge Code |
9409690001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.45
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.27
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.27
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.27
|
| Rate for Payer: United Healthcare VA CCN |
$43.27
|
|
|
ULTRAVIOLET LIGHT THERAPY
|
Facility
|
IP
|
$96.16
|
|
|
Service Code
|
CPT 96900
|
| Hospital Charge Code |
9409690001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.93
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
|
|
UNIVERSAL PACK
|
Facility
|
OP
|
$93.22
|
|
| Hospital Charge Code |
2720061391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.29 |
| Max. Negotiated Rate |
$88.56 |
| Rate for Payer: Aetna of VT Commercial |
$88.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.11
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cigna Commercial |
$74.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.95
|
| Rate for Payer: Multiplan Commercial |
$86.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.95
|
| Rate for Payer: United Healthcare Commercial |
$88.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.95
|
| Rate for Payer: United Healthcare VA CCN |
$41.95
|
|
|
UNIVERSAL PACK
|
Facility
|
IP
|
$93.22
|
|
| Hospital Charge Code |
2720061391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$88.56 |
| Rate for Payer: Aetna of VT Commercial |
$88.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.58
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cigna Commercial |
$74.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.58
|
| Rate for Payer: Multiplan Commercial |
$86.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.24
|
| Rate for Payer: United Healthcare Commercial |
$88.56
|
|
|
UNLISTED CHEMISTRY PROCEDURE
|
Facility
|
IP
|
$333.88
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3008499901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: Aetna of VT Commercial |
$317.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.10
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cigna Commercial |
$267.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.10
|
| Rate for Payer: Multiplan Commercial |
$310.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.80
|
| Rate for Payer: United Healthcare Commercial |
$317.19
|
|
|
UNLISTED CHEMISTRY PROCEDURE
|
Facility
|
OP
|
$333.88
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3008499901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$317.19 |
| Rate for Payer: Aetna of VT Commercial |
$317.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.43
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Cigna Commercial |
$267.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.25
|
| Rate for Payer: Multiplan Commercial |
$310.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.25
|
| Rate for Payer: United Healthcare Commercial |
$317.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.25
|
| Rate for Payer: United Healthcare VA CCN |
$150.25
|
|
|
UNLISTED CHEMISTRY PROCEDURE
|
Professional
|
Both
|
$333.88
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3008499901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$313.85 |
| Rate for Payer: Aetna of VT Commercial |
$313.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.12
|
| Rate for Payer: Cash Price |
$166.94
|
| Rate for Payer: Multiplan Commercial |
$310.51
|
| Rate for Payer: United Healthcare Commercial |
$283.80
|
| Rate for Payer: United Healthcare VA CCN |
$133.55
|
|
|
UNLISTED LAPS PX OVIDCT OVRY
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
CPT 58679
|
| Hospital Charge Code |
9825867901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$581.60 |
| Max. Negotiated Rate |
$1,366.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,366.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,302.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,302.64
|
| Rate for Payer: Cash Price |
$727.00
|
| Rate for Payer: Multiplan Commercial |
$1,352.22
|
| Rate for Payer: United Healthcare Commercial |
$1,235.90
|
| Rate for Payer: United Healthcare VA CCN |
$581.60
|
|
|
UNLISTED LAPS PX OVIDCT OVRY
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 58679
|
| Hospital Charge Code |
9825867901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$643.98 |
| Max. Negotiated Rate |
$1,381.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,381.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,302.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$643.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,302.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$875.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,235.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,177.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$654.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,155.93
|
| Rate for Payer: Cash Price |
$727.00
|
| Rate for Payer: Cigna Commercial |
$1,163.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,163.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,163.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$654.30
|
| Rate for Payer: Multiplan Commercial |
$1,352.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,235.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$654.30
|
| Rate for Payer: United Healthcare Commercial |
$1,381.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$654.30
|
| Rate for Payer: United Healthcare VA CCN |
$654.30
|
|
|
UNLISTED LAPS PX OVIDCT OVRY
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 58679
|
| Hospital Charge Code |
9825867901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,076.11 |
| Max. Negotiated Rate |
$1,381.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,381.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,076.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,076.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,235.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,221.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,163.20
|
| Rate for Payer: Cash Price |
$727.00
|
| Rate for Payer: Cigna Commercial |
$1,163.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,163.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,163.20
|
| Rate for Payer: Multiplan Commercial |
$1,352.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,235.90
|
| Rate for Payer: United Healthcare Commercial |
$1,381.30
|
|
|
UNLISTED MICROBIOLOGY PX
|
Facility
|
OP
|
$444.62
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
3008799901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.92 |
| Max. Negotiated Rate |
$422.39 |
| Rate for Payer: Aetna of VT Commercial |
$422.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$267.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$360.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$353.47
|
| Rate for Payer: Cash Price |
$222.31
|
| Rate for Payer: Cigna Commercial |
$355.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$355.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$355.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.08
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.08
|
| Rate for Payer: United Healthcare Commercial |
$422.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.08
|
| Rate for Payer: United Healthcare VA CCN |
$200.08
|
|
|
UNLISTED MICROBIOLOGY PX
|
Facility
|
IP
|
$444.62
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
3008799901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$329.06 |
| Max. Negotiated Rate |
$422.39 |
| Rate for Payer: Aetna of VT Commercial |
$422.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$329.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$329.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$373.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.70
|
| Rate for Payer: Cash Price |
$222.31
|
| Rate for Payer: Cigna Commercial |
$355.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$355.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$355.70
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.93
|
| Rate for Payer: United Healthcare Commercial |
$422.39
|
|
|
UNLISTED MICROBIOLOGY PX
|
Professional
|
Both
|
$444.62
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
3008799901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$417.94 |
| Rate for Payer: Aetna of VT Commercial |
$417.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.34
|
| Rate for Payer: Cash Price |
$222.31
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: United Healthcare Commercial |
$377.93
|
| Rate for Payer: United Healthcare VA CCN |
$177.85
|
|
|
UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3108147901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$928.32 |
| Max. Negotiated Rate |
$1,991.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,991.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,877.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$928.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,877.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,261.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,781.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,697.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$943.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,666.32
|
| Rate for Payer: Cash Price |
$1,048.00
|
| Rate for Payer: Cigna Commercial |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,676.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$1,949.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,781.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$943.20
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$943.20
|
| Rate for Payer: United Healthcare VA CCN |
$943.20
|
|
|
UNLISTED MOLECULAR PATHOLOGY
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3108147901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$838.40 |
| Max. Negotiated Rate |
$1,970.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,970.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,877.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,877.81
|
| Rate for Payer: Cash Price |
$1,048.00
|
| Rate for Payer: Multiplan Commercial |
$1,949.28
|
| Rate for Payer: United Healthcare Commercial |
$1,781.60
|
| Rate for Payer: United Healthcare VA CCN |
$838.40
|
|
|
UNLISTED MOLECULAR PATHOLOGY
|
Facility
|
IP
|
$2,096.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3108147901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,551.25 |
| Max. Negotiated Rate |
$1,991.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,991.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,551.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,551.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,781.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,760.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,048.00
|
| Rate for Payer: Cigna Commercial |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,676.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,676.80
|
| Rate for Payer: Multiplan Commercial |
$1,949.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,781.60
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
|
