|
CHRNC CARE MGMT PHYS 1ST 30
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
9609949101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$443.68 |
| Rate for Payer: Aetna of VT Commercial |
$443.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.17
|
| 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 |
$139.17
|
| 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 |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.05
|
| 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 |
$121.05
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.39
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| 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
|
|
|
CHRNC CARE MGMT PHYS 1ST 30
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
5109949101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$221.84 |
| Rate for Payer: Aetna of VT Commercial |
$221.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.17
|
| 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 |
$139.17
|
| 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 |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.05
|
| 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 |
$121.05
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.39
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| 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
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
5109943901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna of VT Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$35.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare Commercial |
$49.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare VA CCN |
$32.31
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna of VT Commercial |
$212.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.20
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.40
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.04
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare VA CCN |
$50.40
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.89 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
5109943901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.89 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna of VT Commercial |
$212.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.08
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare VA CCN |
$100.80
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Aetna of VT Commercial |
$210.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$35.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare Commercial |
$49.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare VA CCN |
$32.31
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
9609943902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.31 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna of VT Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$35.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.15
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare Commercial |
$49.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.31
|
| Rate for Payer: United Healthcare VA CCN |
$32.31
|
|
|
CHRNC CARE MGMT STAF EA ADDL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
5109943901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.04
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare VA CCN |
$50.40
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
5109949001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna of VT Commercial |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.73
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$51.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$52.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: United Healthcare VA CCN |
$24.75
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna of VT Commercial |
$108.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.20
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$106.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.90
|
| Rate for Payer: United Healthcare Commercial |
$108.30
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$125.08 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna of VT Commercial |
$160.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.20
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$135.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$135.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$135.20
|
| Rate for Payer: Multiplan Commercial |
$157.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.65
|
| Rate for Payer: United Healthcare Commercial |
$160.55
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$158.86 |
| Rate for Payer: Aetna of VT Commercial |
$158.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.70
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$157.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare Commercial |
$72.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare VA CCN |
$46.84
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
5109949001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$96.18 |
| Rate for Payer: Aetna of VT Commercial |
$51.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.70
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$51.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare Commercial |
$72.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare VA CCN |
$46.84
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna of VT Commercial |
$160.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.35
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$135.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$135.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$135.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.05
|
| Rate for Payer: Multiplan Commercial |
$157.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.05
|
| Rate for Payer: United Healthcare Commercial |
$160.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.05
|
| Rate for Payer: United Healthcare VA CCN |
$76.05
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna of VT Commercial |
$108.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.63
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.30
|
| Rate for Payer: Multiplan Commercial |
$106.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.30
|
| Rate for Payer: United Healthcare Commercial |
$108.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.30
|
| Rate for Payer: United Healthcare VA CCN |
$51.30
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
9609949002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna of VT Commercial |
$107.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.37
|
| Rate for Payer: Multiplan Commercial |
$106.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare Commercial |
$72.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.84
|
| Rate for Payer: United Healthcare VA CCN |
$46.84
|
|
|
CHRNC CARE MGMT STAFF 1ST 20
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
5109949001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna of VT Commercial |
$52.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$44.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$51.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.75
|
| Rate for Payer: United Healthcare Commercial |
$52.25
|
|
|
CHROMOSOME ANALYSIS 15-20
|
Facility
|
IP
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
6368826201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$376.51 |
| Max. Negotiated Rate |
$483.29 |
| Rate for Payer: Aetna of VT Commercial |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$427.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.98
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.98
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.42
|
| Rate for Payer: United Healthcare Commercial |
$483.29
|
|
|
CHROMOSOME ANALYSIS 15-20
|
Facility
|
IP
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
3008826201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$376.51 |
| Max. Negotiated Rate |
$483.29 |
| Rate for Payer: Aetna of VT Commercial |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$427.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.98
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.98
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.42
|
| Rate for Payer: United Healthcare Commercial |
$483.29
|
|
|
CHROMOSOME ANALYSIS 15-20
|
Professional
|
Both
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
3008826201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$618.35 |
| Rate for Payer: Aetna of VT Commercial |
$478.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$618.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$618.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$214.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.49
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$151.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.73
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare Commercial |
$193.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare VA CCN |
$125.49
|
|
|
CHROMOSOME ANALYSIS 15-20
|
Facility
|
OP
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
6368826201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$225.32 |
| Max. Negotiated Rate |
$483.29 |
| Rate for Payer: Aetna of VT Commercial |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$404.44
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.93
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$228.93
|
| Rate for Payer: United Healthcare Commercial |
$483.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.93
|
| Rate for Payer: United Healthcare VA CCN |
$228.93
|
|
|
CHROMOSOME ANALYSIS 15-20
|
Professional
|
Both
|
$508.73
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
6368826201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$618.35 |
| Rate for Payer: Aetna of VT Commercial |
$478.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$618.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$618.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$214.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.49
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cash Price |
$254.36
|
| Rate for Payer: Cigna Commercial |
$151.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.73
|
| Rate for Payer: Multiplan Commercial |
$473.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare Commercial |
$193.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare VA CCN |
$125.49
|
|
