|
ECG MONIT/REPRT UP TO 48 HRS
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 93225 26
|
| Hospital Charge Code |
9729322501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$51.47 |
| Rate for Payer: Aetna of VT Commercial |
$42.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.47
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$41.85
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare VA CCN |
$18.00
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 93225 26
|
| Hospital Charge Code |
9729322501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna of VT Commercial |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.77
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$36.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$41.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.25
|
| Rate for Payer: United Healthcare VA CCN |
$20.25
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 93225 26
|
| Hospital Charge Code |
9729322501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna of VT Commercial |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$36.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$41.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9859322701
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$127.84 |
| Rate for Payer: Aetna of VT Commercial |
$127.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.35
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$39.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.28
|
| Rate for Payer: United Healthcare Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.28
|
| Rate for Payer: United Healthcare VA CCN |
$17.28
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
9859322701
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$60.23 |
| 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 |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.12
|
| 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: Martins Point Health Care Commercial |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare VA CCN |
$61.20
|
|
|
ECG MONIT/REPRT UP TO 48 HRS
|
Facility
|
IP
|
$642.11
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Aetna of VT Commercial |
$610.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$475.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$475.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$545.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$539.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$513.69
|
| Rate for Payer: Cash Price |
$321.06
|
| Rate for Payer: Cigna Commercial |
$513.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.69
|
| Rate for Payer: Multiplan Commercial |
$597.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.79
|
| Rate for Payer: United Healthcare Commercial |
$610.00
|
|
|
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
|
|
|
ECG/REVIEW INTERPRET ONLY
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
9859327201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.11
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.65
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare VA CCN |
$43.65
|
|
|
ECG/REVIEW INTERPRET ONLY
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
9859327201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
|
|
ECG/REVIEW INTERPRET ONLY
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
9859327201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Aetna of VT Commercial |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.39
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$52.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.62
|
| Rate for Payer: United Healthcare Commercial |
$34.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.62
|
| Rate for Payer: United Healthcare VA CCN |
$22.62
|
|
|
ECG ROUTINE 12 LDS/> I&R ONLY
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
9859301001
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna of VT Commercial |
$59.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.97
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$17.57
|
| 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 |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$11.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare VA CCN |
$7.59
|
|
|
ECG ROUTINE 12 LDS/> I&R ONLY
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
9859301001
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna of VT Commercial |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.35
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.35
|
| Rate for Payer: United Healthcare Commercial |
$59.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.35
|
| Rate for Payer: United Healthcare VA CCN |
$28.35
|
|
|
ECG ROUTINE 12 LDS/> I&R ONLY
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
9859301001
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna of VT Commercial |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.55
|
| Rate for Payer: United Healthcare Commercial |
$59.85
|
|
|
ECG ROUTINE 12LDS/> TRCG ONLY
|
Facility
|
IP
|
$200.60
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna of VT Commercial |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.48
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cigna Commercial |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.48
|
| Rate for Payer: Multiplan Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$190.57
|
|
|
ECG ROUTINE 12LDS/> TRCG ONLY
|
Professional
|
Both
|
$200.60
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$188.56 |
| Rate for Payer: Aetna of VT Commercial |
$188.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.71
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cigna Commercial |
$13.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.95
|
| Rate for Payer: United Healthcare Commercial |
$9.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.95
|
| Rate for Payer: United Healthcare VA CCN |
$5.95
|
|
|
ECG ROUTINE 12LDS/> TRCG ONLY
|
Facility
|
OP
|
$200.60
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$88.85 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna of VT Commercial |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.48
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cigna Commercial |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.27
|
| Rate for Payer: Multiplan Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.27
|
| Rate for Payer: United Healthcare Commercial |
$190.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.27
|
| Rate for Payer: United Healthcare VA CCN |
$90.27
|
|
|
ECHO EXAM UTERUS
|
Facility
|
OP
|
$628.67
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
4027683101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$278.44 |
| Max. Negotiated Rate |
$597.24 |
| Rate for Payer: Aetna of VT Commercial |
$597.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$509.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$499.79
|
| Rate for Payer: Cash Price |
$314.34
|
| Rate for Payer: Cash Price |
$314.34
|
| Rate for Payer: Cigna Commercial |
$502.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$282.90
|
| Rate for Payer: Multiplan Commercial |
$584.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$282.90
|
| Rate for Payer: United Healthcare Commercial |
$597.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.90
|
| Rate for Payer: United Healthcare VA CCN |
$282.90
|
|
|
ECHO EXAM UTERUS
|
Facility
|
IP
|
$628.67
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
4027683101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$465.28 |
| Max. Negotiated Rate |
$597.24 |
| Rate for Payer: Aetna of VT Commercial |
$597.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$502.94
|
| Rate for Payer: Cash Price |
$314.34
|
| Rate for Payer: Cigna Commercial |
$502.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$502.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$502.94
|
| Rate for Payer: Multiplan Commercial |
$584.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.37
|
| Rate for Payer: United Healthcare Commercial |
$597.24
|
|
|
ECHO EXAM UTERUS INTERPRETATIO
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
9727683101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna of VT Commercial |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.60
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.60
|
| Rate for Payer: Multiplan Commercial |
$220.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.45
|
| Rate for Payer: United Healthcare Commercial |
$225.15
|
|
|
ECHO EXAM UTERUS INTERPRETATIO
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
9727683101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$356.68 |
| Rate for Payer: Aetna of VT Commercial |
$222.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.12
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$169.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.40
|
| Rate for Payer: Multiplan Commercial |
$220.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.40
|
| Rate for Payer: United Healthcare Commercial |
$168.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.40
|
| Rate for Payer: United Healthcare VA CCN |
$109.40
|
|
|
ECHO EXAM UTERUS INTERPRETATIO
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
9727683101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.97 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna of VT Commercial |
$225.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.41
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$189.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$189.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.65
|
| Rate for Payer: Multiplan Commercial |
$220.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.65
|
| Rate for Payer: United Healthcare Commercial |
$225.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.65
|
| Rate for Payer: United Healthcare VA CCN |
$106.65
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9727694201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$364.13 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Aetna of VT Commercial |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.60
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9727694201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$217.91 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Aetna of VT Commercial |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.14
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare VA CCN |
$221.40
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9829331201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$445.56 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Aetna of VT Commercial |
$955.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$445.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$605.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$855.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$814.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$799.77
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$804.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$804.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$804.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$452.70
|
| Rate for Payer: Multiplan Commercial |
$935.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$452.70
|
| Rate for Payer: United Healthcare Commercial |
$955.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$452.70
|
| Rate for Payer: United Healthcare VA CCN |
$452.70
|
|
|
ECHO TRANSESOPHAGEAL
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$222.86 |
| Max. Negotiated Rate |
$945.64 |
| Rate for Payer: Aetna of VT Commercial |
$945.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$901.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$393.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.31
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$521.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.87
|
| Rate for Payer: Multiplan Commercial |
$935.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$316.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$222.86
|
| Rate for Payer: United Healthcare Commercial |
$342.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.86
|
| Rate for Payer: United Healthcare VA CCN |
$222.86
|
|
