|
UNLISTED PX HANDS/FINGERS
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
9822698901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$455.20 |
| Max. Negotiated Rate |
$1,069.72 |
| Rate for Payer: Aetna of VT Commercial |
$1,069.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.53
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: United Healthcare Commercial |
$967.30
|
| Rate for Payer: United Healthcare VA CCN |
$455.20
|
|
|
UNLISTED PX HANDS/FINGERS
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
9822698901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$842.23 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,081.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$842.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$842.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$967.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$955.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$910.40
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cigna Commercial |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$910.40
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$967.30
|
| Rate for Payer: United Healthcare Commercial |
$1,081.10
|
|
|
UNLISTED PX HANDS/FINGERS
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
9822698901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$504.02 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,081.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$504.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$685.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$967.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$921.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$512.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$904.71
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cigna Commercial |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$910.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$512.10
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$967.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$512.10
|
| Rate for Payer: United Healthcare Commercial |
$1,081.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.10
|
| Rate for Payer: United Healthcare VA CCN |
$512.10
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$134.42
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9209392201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$59.53 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.86
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.49
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.49
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.49
|
| Rate for Payer: United Healthcare VA CCN |
$60.49
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9729392201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$244.97 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.80
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$134.42
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9209392201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.54
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9609392202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1,553.16 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$416.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$465.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.89
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$631.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$650.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$650.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.52
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$622.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare VA CCN |
$404.52
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9609392202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9729392201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Aetna of VT Commercial |
$311.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.74
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$93.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.98
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare Commercial |
$119.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare VA CCN |
$77.98
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9609392202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9609392201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9729392201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna of VT Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.14
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.95
|
| Rate for Payer: Multiplan Commercial |
$307.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare Commercial |
$314.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.95
|
| Rate for Payer: United Healthcare VA CCN |
$148.95
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5109392201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5109392201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9609392201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
9609392201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$144.74 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.74
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$93.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.98
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare Commercial |
$119.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare VA CCN |
$77.98
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5109392201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$144.74 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.74
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$93.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.98
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare Commercial |
$119.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.98
|
| Rate for Payer: United Healthcare VA CCN |
$77.98
|
|
|
UR ALBUMIN QUANTITATIVE
|
Facility
|
OP
|
$83.44
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3008204301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna of VT Commercial |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.33
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cigna Commercial |
$66.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.55
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.55
|
| Rate for Payer: United Healthcare Commercial |
$79.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare VA CCN |
$37.55
|
|
|
UR ALBUMIN QUANTITATIVE
|
Facility
|
IP
|
$83.44
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3008204301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna of VT Commercial |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.75
|
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Cigna Commercial |
$66.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.92
|
| Rate for Payer: United Healthcare Commercial |
$79.27
|
|
|
URINALYSIS AUTO W/O SCOPE
|
Facility
|
OP
|
$31.02
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3008100301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.66
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.96
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare VA CCN |
$13.96
|
|
|
URINALYSIS AUTO W/O SCOPE
|
Facility
|
IP
|
$31.02
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3008100301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.82
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.37
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
|
|
URINALYSIS AUTO W/O SCOPE
|
Professional
|
Both
|
$31.02
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
3008100301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of VT Commercial |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.84
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$2.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$3.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare VA CCN |
$2.25
|
|
|
URINALYSIS AUTO W/SCOPE
|
Facility
|
OP
|
$79.62
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3008100101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Aetna of VT Commercial |
$75.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.30
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cigna Commercial |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.83
|
| Rate for Payer: United Healthcare Commercial |
$75.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare VA CCN |
$35.83
|
|
|
URINALYSIS AUTO W/SCOPE
|
Facility
|
IP
|
$79.62
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3008100101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Aetna of VT Commercial |
$75.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.70
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cigna Commercial |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.68
|
| Rate for Payer: United Healthcare Commercial |
$75.64
|
|
|
URINALYSIS AUTO W/SCOPE
|
Professional
|
Both
|
$79.62
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
3008100101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: Aetna of VT Commercial |
$74.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.42
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare Commercial |
$4.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare VA CCN |
$3.17
|
|
