|
DNA ANTIBODY NATIVE/DOUBLE STR
|
Facility
|
OP
|
$191.94
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3008622501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$182.34 |
| Rate for Payer: Aetna of VT Commercial |
$182.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.59
|
| Rate for Payer: Cash Price |
$95.97
|
| Rate for Payer: Cash Price |
$95.97
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.37
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.37
|
| Rate for Payer: United Healthcare Commercial |
$182.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare VA CCN |
$86.37
|
|
|
DNA ANTIBODY NATIVE/DOUBLE STR
|
Professional
|
Both
|
$191.94
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3008622501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$180.42 |
| Rate for Payer: Aetna of VT Commercial |
$180.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.48
|
| Rate for Payer: Cash Price |
$95.97
|
| Rate for Payer: Cash Price |
$95.97
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$21.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare VA CCN |
$13.74
|
|
|
DNA ANTIBODY NATIVE/DOUBLE STR
|
Facility
|
IP
|
$191.94
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3008622501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.05 |
| Max. Negotiated Rate |
$182.34 |
| Rate for Payer: Aetna of VT Commercial |
$182.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.55
|
| Rate for Payer: Cash Price |
$95.97
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.55
|
| Rate for Payer: Multiplan Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.15
|
| Rate for Payer: United Healthcare Commercial |
$182.34
|
|
|
DOCUSATE 100 MG/10 ML UD CUP
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
DOCUSATE 100 MG/10 ML UD CUP
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 121187010
|
| Hospital Charge Code |
2500000096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 99336
|
| Hospital Charge Code |
9839933601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$903.66 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,159.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$903.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$903.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,025.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$976.80
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cigna Commercial |
$976.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$976.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$976.80
|
| Rate for Payer: Multiplan Commercial |
$1,135.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,037.85
|
| Rate for Payer: United Healthcare Commercial |
$1,159.95
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
CPT 99336
|
| Hospital Charge Code |
9839933601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,147.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,147.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,093.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,093.89
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$1,135.53
|
| Rate for Payer: United Healthcare Commercial |
$1,037.85
|
| Rate for Payer: United Healthcare VA CCN |
$488.40
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 99336
|
| Hospital Charge Code |
9839933601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$540.78 |
| Max. Negotiated Rate |
$1,159.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,159.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,093.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$540.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,093.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$735.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$989.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$549.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$970.70
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cigna Commercial |
$976.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$976.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$976.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$549.45
|
| Rate for Payer: Multiplan Commercial |
$1,135.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,037.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$549.45
|
| Rate for Payer: United Healthcare Commercial |
$1,159.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.45
|
| Rate for Payer: United Healthcare VA CCN |
$549.45
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 99337
|
| Hospital Charge Code |
9839933701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$683.11 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: Aetna of VT Commercial |
$876.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$683.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$683.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$784.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$775.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$738.40
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cigna Commercial |
$738.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$738.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$738.40
|
| Rate for Payer: Multiplan Commercial |
$858.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$784.55
|
| Rate for Payer: United Healthcare Commercial |
$876.85
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
CPT 99337
|
| Hospital Charge Code |
9839933701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$867.62 |
| Rate for Payer: Aetna of VT Commercial |
$867.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$826.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$826.92
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Multiplan Commercial |
$858.39
|
| Rate for Payer: United Healthcare Commercial |
$784.55
|
| Rate for Payer: United Healthcare VA CCN |
$369.20
|
|
|
DOMICIL/R-HOME EST PAT 40 MIN
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 99337
|
| Hospital Charge Code |
9839933701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$408.80 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: Aetna of VT Commercial |
$876.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$826.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$408.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$826.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$555.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$784.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$747.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$415.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$733.78
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cigna Commercial |
$738.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$738.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$738.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$415.35
|
| Rate for Payer: Multiplan Commercial |
$858.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$784.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$415.35
|
| Rate for Payer: United Healthcare Commercial |
$876.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.35
|
| Rate for Payer: United Healthcare VA CCN |
$415.35
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$564.94 |
| Rate for Payer: Aetna of VT Commercial |
$564.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.60
|
| 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 Medicare Advantage |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.95
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$52.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare Commercial |
$33.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare VA CCN |
$21.86
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.60
|
| 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 Medicare Advantage |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.95
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$52.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare Commercial |
$33.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare VA CCN |
$21.86
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5109332501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.57
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.70
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare VA CCN |
$200.70
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna of VT Commercial |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$266.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$486.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$477.80
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$270.45
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.45
|
| Rate for Payer: United Healthcare Commercial |
$570.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.45
|
| Rate for Payer: United Healthcare VA CCN |
$270.45
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna of VT Commercial |
$570.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$444.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$444.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$504.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$480.80
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.80
|
| Rate for Payer: Multiplan Commercial |
$558.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.85
|
| Rate for Payer: United Healthcare Commercial |
$570.95
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
9609332502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5109332501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.80
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
|
|
DOPPLER COLOR FLOW ADD-ON
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5109332501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$419.24 |
| Rate for Payer: Aetna of VT Commercial |
$419.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.60
|
| 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 Medicare Advantage |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.95
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$52.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.86
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare Commercial |
$33.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.86
|
| Rate for Payer: United Healthcare VA CCN |
$21.86
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
9829332101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna of VT Commercial |
$40.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.40
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$40.85
|
|
|
DOPPLER ECHO EXAM HEART
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$243.46 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.18
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$112.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.96
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare VA CCN |
$47.96
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5109332001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$560.26 |
| Max. Negotiated Rate |
$719.15 |
| Rate for Payer: Aetna of VT Commercial |
$719.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$560.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$560.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$643.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$635.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$605.60
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$605.60
|
| Rate for Payer: Multiplan Commercial |
$704.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$643.45
|
| Rate for Payer: United Healthcare Commercial |
$719.15
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
OP
|
$475.64
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4809332101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$451.86 |
| Rate for Payer: Aetna of VT Commercial |
$451.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$426.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$426.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$286.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.13
|
| Rate for Payer: Cash Price |
$237.82
|
| Rate for Payer: Cigna Commercial |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.04
|
| Rate for Payer: Multiplan Commercial |
$442.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.04
|
| Rate for Payer: United Healthcare Commercial |
$451.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.04
|
| Rate for Payer: United Healthcare VA CCN |
$214.04
|
|
|
DOPPLER ECHO EXAM HEART
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
9609332001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$449.99 |
| Max. Negotiated Rate |
$965.20 |
| Rate for Payer: Aetna of VT Commercial |
$965.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$449.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$910.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$611.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$863.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.72
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cigna Commercial |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$812.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$812.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$457.20
|
| Rate for Payer: Multiplan Commercial |
$944.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$457.20
|
| Rate for Payer: United Healthcare Commercial |
$965.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$457.20
|
| Rate for Payer: United Healthcare VA CCN |
$457.20
|
|
