|
ADM SARSCV2 30MCG TRS-SUCR 1
|
Facility
|
OP
|
$57.90
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$55.01 |
| Rate for Payer: Aetna of VT Commercial |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.03
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.05
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare VA CCN |
$26.05
|
|
|
ADM SARSCV2 30MCG TRS-SUCR 1
|
Professional
|
Both
|
$57.90
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.16 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna of VT Commercial |
$54.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$40.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.44
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: United Healthcare Commercial |
$49.22
|
| Rate for Payer: United Healthcare VA CCN |
$23.16
|
|
|
ADNA HEPATITIS B VIRUS QUANTIF
|
Professional
|
Both
|
$323.64
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3008751701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$304.22 |
| Rate for Payer: Aetna of VT Commercial |
$304.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.22
|
| Rate for Payer: Cash Price |
$161.82
|
| Rate for Payer: Cash Price |
$161.82
|
| Rate for Payer: Cigna Commercial |
$51.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$300.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$65.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$42.84
|
|
|
ADNA HEPATITIS B VIRUS QUANTIF
|
Facility
|
OP
|
$323.64
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3008751701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$307.46 |
| Rate for Payer: Aetna of VT Commercial |
$307.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.29
|
| Rate for Payer: Cash Price |
$161.82
|
| Rate for Payer: Cash Price |
$161.82
|
| Rate for Payer: Cigna Commercial |
$258.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.64
|
| Rate for Payer: Multiplan Commercial |
$300.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.64
|
| Rate for Payer: United Healthcare Commercial |
$307.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$145.64
|
|
|
ADNA HEPATITIS B VIRUS QUANTIF
|
Facility
|
IP
|
$323.64
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3008751701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$239.53 |
| Max. Negotiated Rate |
$307.46 |
| Rate for Payer: Aetna of VT Commercial |
$307.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.91
|
| Rate for Payer: Cash Price |
$161.82
|
| Rate for Payer: Cigna Commercial |
$258.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.91
|
| Rate for Payer: Multiplan Commercial |
$300.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.09
|
| Rate for Payer: United Healthcare Commercial |
$307.46
|
|
|
ADRENALIN EPINEPHRINE INJ JR
|
Facility
|
OP
|
$135.78
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
636J017107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$128.99 |
| Rate for Payer: Aetna of VT Commercial |
$128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.95
|
| Rate for Payer: Cash Price |
$67.89
|
| Rate for Payer: Cash Price |
$67.89
|
| Rate for Payer: Cigna Commercial |
$108.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.10
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.10
|
| Rate for Payer: United Healthcare Commercial |
$128.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.10
|
| Rate for Payer: United Healthcare VA CCN |
$61.10
|
|
|
ADRENALIN EPINEPHRINE INJ JR
|
Professional
|
Both
|
$2.01
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
636J017107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.73
|
|
|
ADRENALIN EPINEPHRINE INJ JR
|
Facility
|
IP
|
$135.78
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
636J017107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$128.99 |
| Rate for Payer: Aetna of VT Commercial |
$128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.62
|
| Rate for Payer: Cash Price |
$67.89
|
| Rate for Payer: Cigna Commercial |
$108.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.62
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.41
|
| Rate for Payer: United Healthcare Commercial |
$128.99
|
|
|
ADRENOCORTICOTROPIC HORM ACTH
|
Facility
|
IP
|
$546.99
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
3008202401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$404.83 |
| Max. Negotiated Rate |
$519.64 |
| Rate for Payer: Aetna of VT Commercial |
$519.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$404.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$404.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$459.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$437.59
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.59
|
| Rate for Payer: Multiplan Commercial |
$508.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$464.94
|
| Rate for Payer: United Healthcare Commercial |
$519.64
|
|
|
ADRENOCORTICOTROPIC HORM ACTH
|
Professional
|
Both
|
$546.99
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
3008202401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$514.17 |
| Rate for Payer: Aetna of VT Commercial |
$514.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.01
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.08
|
| Rate for Payer: Multiplan Commercial |
$508.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.62
|
| Rate for Payer: United Healthcare Commercial |
$59.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.62
|
| Rate for Payer: United Healthcare VA CCN |
$38.62
|
|
|
ADRENOCORTICOTROPIC HORM ACTH
|
Facility
|
OP
|
$546.99
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
3008202401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$519.64 |
| Rate for Payer: Aetna of VT Commercial |
$519.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$242.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$329.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$246.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.86
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.15
|
| Rate for Payer: Multiplan Commercial |
$508.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$464.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$246.15
|
| Rate for Payer: United Healthcare Commercial |
$519.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.62
|
| Rate for Payer: United Healthcare VA CCN |
$246.15
|
|
|
ADULT DAY 15 MIN
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
783600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.14
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare VA CCN |
$2.91
|
|
|
ADULT DAY 15 MIN
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
783600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.17
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
|
|
ADULT DAY HEALTH SERVICE
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
993600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.17
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
|
|
ADULT DAY HEALTH SERVICE
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
993600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.14
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare VA CCN |
$2.91
|
|
|
ADULT DAY MODERATE NEEDS
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
963600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.14
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.91
|
| Rate for Payer: United Healthcare VA CCN |
$2.91
|
|
|
ADULT DAY MODERATE NEEDS
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
HCPCS S5100
|
| Hospital Charge Code |
963600001
|
|
Hospital Revenue Code
|
3104
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Aetna of VT Commercial |
$6.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.17
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cigna Commercial |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$6.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.49
|
| Rate for Payer: United Healthcare Commercial |
$6.14
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Aetna of VT Commercial |
$115.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.99
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.90
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.90
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.90
|
| Rate for Payer: United Healthcare VA CCN |
$54.90
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$126.51 |
| Rate for Payer: Aetna of VT Commercial |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.90
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.82
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$108.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare VA CCN |
$70.75
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
9609949702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Aetna of VT Commercial |
$115.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.60
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.70
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
9609949702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$230.30 |
| Rate for Payer: Aetna of VT Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.90
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.82
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$108.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare VA CCN |
$70.75
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
9609949701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
9609949702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
ADVNCD CARE PLAN 30 MIN
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
9609949701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$230.30 |
| Rate for Payer: Aetna of VT Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.90
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$126.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$126.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.82
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare Commercial |
$108.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.75
|
| Rate for Payer: United Healthcare VA CCN |
$70.75
|
|
