|
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 ADDL 30 MIN
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.93
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare VA CCN |
$96.75
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$202.10 |
| Rate for Payer: Aetna of VT Commercial |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.17
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare Commercial |
$102.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare VA CCN |
$66.88
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$317.50 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Aetna of VT Commercial |
$407.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$360.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$343.20
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.65
|
| Rate for Payer: United Healthcare Commercial |
$407.55
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$403.26 |
| Rate for Payer: Aetna of VT Commercial |
$403.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.17
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare Commercial |
$102.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare VA CCN |
$66.88
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$202.10 |
| Rate for Payer: Aetna of VT Commercial |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.17
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare Commercial |
$102.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.88
|
| Rate for Payer: United Healthcare VA CCN |
$66.88
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
9609949801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Aetna of VT Commercial |
$407.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$384.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$347.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.06
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$343.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$343.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.05
|
| Rate for Payer: Multiplan Commercial |
$398.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.05
|
| Rate for Payer: United Healthcare Commercial |
$407.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.05
|
| Rate for Payer: United Healthcare VA CCN |
$193.05
|
|
|
ADVNCD CARE PLAN ADDL 30 MIN
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.93
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare VA CCN |
$96.75
|
|
|
AIRWAY INHALATION TREATMENT
|
Facility
|
IP
|
$196.46
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$186.64 |
| Rate for Payer: Aetna of VT Commercial |
$186.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.17
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.17
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.99
|
| Rate for Payer: United Healthcare Commercial |
$186.64
|
|
|
AIRWAY INHALATION TREATMENT
|
Facility
|
OP
|
$196.46
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$186.64 |
| Rate for Payer: Aetna of VT Commercial |
$186.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.19
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.41
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.41
|
| Rate for Payer: United Healthcare Commercial |
$186.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.41
|
| Rate for Payer: United Healthcare VA CCN |
$88.41
|
|
|
AIRWAY INHALATION TREATMENT
|
Professional
|
Both
|
$196.46
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Aetna of VT Commercial |
$184.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.87
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$11.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.56
|
| Rate for Payer: United Healthcare Commercial |
$11.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.56
|
| Rate for Payer: United Healthcare VA CCN |
$7.56
|
|
|
AIRWY NASOPHARY 12
|
Facility
|
OP
|
$3.68
|
|
| Hospital Charge Code |
2720043601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of VT Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.93
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna Commercial |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.66
|
| Rate for Payer: United Healthcare VA CCN |
$1.66
|
|
|
AIRWY NASOPHARY 12
|
Facility
|
IP
|
$3.68
|
|
| Hospital Charge Code |
2720043601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of VT Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.94
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna Commercial |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.13
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
|
|
AIRWY NASOPHARY 14
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
2720043611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.15
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare VA CCN |
$1.22
|
|
|
AIRWY NASOPHARY 14
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
2720043611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
|
|
AIRWY NASOPHARY 16
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
2720043621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.15
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare VA CCN |
$1.22
|
|
|
AIRWY NASOPHARY 16
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
2720043621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
|
|
AIRWY NASOPHARY 18
|
Facility
|
IP
|
$3.68
|
|
| Hospital Charge Code |
2720043631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of VT Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.94
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna Commercial |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.13
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
|
|
AIRWY NASOPHARY 18
|
Facility
|
OP
|
$3.68
|
|
| Hospital Charge Code |
2720043631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of VT Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.93
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna Commercial |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$3.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.66
|
| Rate for Payer: United Healthcare VA CCN |
$1.66
|
|
|
AIRWY NASOPHARY 20
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
2720043641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.15
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare VA CCN |
$1.22
|
|
|
AIRWY NASOPHARY 20
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
2720043641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
|
|
AIRWY NASOPHARY 22
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
2720043651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.17
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
|
|
AIRWY NASOPHARY 22
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
2720043651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna of VT Commercial |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.15
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$2.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.22
|
| Rate for Payer: United Healthcare VA CCN |
$1.22
|
|
