|
DX BRONCHOSCOPE/LAVAGE
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
9813162401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$539.53 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna of VT Commercial |
$692.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$539.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$619.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$583.20
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$583.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.65
|
| Rate for Payer: United Healthcare Commercial |
$692.55
|
|
|
DX BRONCHOSCOPE/LAVAGE
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
9813162401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$123.46 |
| Max. Negotiated Rate |
$685.26 |
| Rate for Payer: Aetna of VT Commercial |
$685.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$411.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$411.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$141.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.44
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna Commercial |
$196.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$242.63
|
| Rate for Payer: Multiplan Commercial |
$677.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.46
|
| Rate for Payer: United Healthcare Commercial |
$189.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.46
|
| Rate for Payer: United Healthcare VA CCN |
$123.46
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
IP
|
$581.21
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
4503152501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$430.15 |
| Max. Negotiated Rate |
$552.15 |
| Rate for Payer: Aetna of VT Commercial |
$552.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$494.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$488.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.97
|
| Rate for Payer: Cash Price |
$290.60
|
| Rate for Payer: Cigna Commercial |
$464.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.97
|
| Rate for Payer: Multiplan Commercial |
$540.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$494.03
|
| Rate for Payer: United Healthcare Commercial |
$552.15
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.22
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$237.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.19
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare Commercial |
$229.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare VA CCN |
$149.10
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9823152501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9823152501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9813152502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.22
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$237.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.19
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare Commercial |
$229.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare VA CCN |
$149.10
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
OP
|
$581.21
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
4503152501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.42 |
| Max. Negotiated Rate |
$552.15 |
| Rate for Payer: Aetna of VT Commercial |
$552.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$257.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$349.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$494.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$462.06
|
| Rate for Payer: Cash Price |
$290.60
|
| Rate for Payer: Cigna Commercial |
$464.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$261.54
|
| Rate for Payer: Multiplan Commercial |
$540.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$494.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$261.54
|
| Rate for Payer: United Healthcare Commercial |
$552.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$261.54
|
| Rate for Payer: United Healthcare VA CCN |
$261.54
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
9823152501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$574.34 |
| Rate for Payer: Aetna of VT Commercial |
$574.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$434.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.22
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$237.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.19
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare Commercial |
$229.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.10
|
| Rate for Payer: United Healthcare VA CCN |
$149.10
|
|
|
DX LMBR SPI PNXR
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9826227001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.20
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
|
|
DX LMBR SPI PNXR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
DX LMBR SPI PNXR
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna of VT Commercial |
$168.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.84
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$80.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.66
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare Commercial |
$89.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare VA CCN |
$57.97
|
|
|
DX LMBR SPI PNXR
|
Facility
|
IP
|
$381.55
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
4506227001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.39 |
| Max. Negotiated Rate |
$362.47 |
| Rate for Payer: Aetna of VT Commercial |
$362.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$282.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$282.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$305.24
|
| Rate for Payer: Cash Price |
$190.78
|
| Rate for Payer: Cigna Commercial |
$305.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.24
|
| Rate for Payer: Multiplan Commercial |
$354.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$324.32
|
| Rate for Payer: United Healthcare Commercial |
$362.47
|
|
|
DX LMBR SPI PNXR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
DX LMBR SPI PNXR
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9826227001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.31
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.55
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare VA CCN |
$80.55
|
|
|
DX LMBR SPI PNXR
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.31
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.55
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.55
|
| Rate for Payer: United Healthcare VA CCN |
$80.55
|
|
|
DX LMBR SPI PNXR
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9826227001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna of VT Commercial |
$168.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.84
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$80.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.66
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare Commercial |
$89.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare VA CCN |
$57.97
|
|
|
DX LMBR SPI PNXR
|
Facility
|
OP
|
$381.55
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
4506227001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.99 |
| Max. Negotiated Rate |
$362.47 |
| Rate for Payer: Aetna of VT Commercial |
$362.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$303.33
|
| Rate for Payer: Cash Price |
$190.78
|
| Rate for Payer: Cigna Commercial |
$305.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$305.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$305.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.70
|
| Rate for Payer: Multiplan Commercial |
$354.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$324.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.70
|
| Rate for Payer: United Healthcare Commercial |
$362.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.70
|
| Rate for Payer: United Healthcare VA CCN |
$171.70
|
|
|
DX LMBR SPI PNXR
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna of VT Commercial |
$170.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.20
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$166.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$170.05
|
|
|
DX LMBR SPI PNXR
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
9816227001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.84
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$80.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.66
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare Commercial |
$89.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.97
|
| Rate for Payer: United Healthcare VA CCN |
$57.97
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9859322701
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.80
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
|
