|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331202
|
|
Hospital Revenue Code
|
981
|
| 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
|
$1.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$521.90 |
| 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 |
$229.55
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$2,488.84
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4809331201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,841.99 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,364.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,841.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,841.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,090.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,991.07
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cigna Commercial |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,991.07
|
| Rate for Payer: Multiplan Commercial |
$2,314.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,115.51
|
| Rate for Payer: United Healthcare Commercial |
$2,364.40
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331201
|
|
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
|
|
|
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
|
Facility
|
OP
|
$2,488.84
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4809331201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,102.31 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,364.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,229.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,102.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,229.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,498.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,015.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,119.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,978.63
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cigna Commercial |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,991.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,119.98
|
| Rate for Payer: Multiplan Commercial |
$2,314.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,115.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,119.98
|
| Rate for Payer: United Healthcare Commercial |
$2,364.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.98
|
| Rate for Payer: United Healthcare VA CCN |
$1,119.98
|
|
|
ECHO TRANSESOPHAGEAL
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9829331201
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$2,488.84
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4509331201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.31 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,364.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,229.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,102.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,229.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,498.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,015.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,119.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,978.63
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cigna Commercial |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,991.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,119.98
|
| Rate for Payer: Multiplan Commercial |
$2,314.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,115.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,119.98
|
| Rate for Payer: United Healthcare Commercial |
$2,364.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,119.98
|
| Rate for Payer: United Healthcare VA CCN |
$1,119.98
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$744.54 |
| 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 |
$744.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$744.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$855.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$845.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$804.80
|
| 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: Multiplan Commercial |
$935.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.10
|
| Rate for Payer: United Healthcare Commercial |
$955.70
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
9819331201
|
|
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
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$2,488.84
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4509331201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,841.99 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,364.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,841.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,841.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,090.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,991.07
|
| Rate for Payer: Cash Price |
$1,244.42
|
| Rate for Payer: Cigna Commercial |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,991.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,991.07
|
| Rate for Payer: Multiplan Commercial |
$2,314.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,115.51
|
| Rate for Payer: United Healthcare Commercial |
$2,364.40
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
IP
|
$994.19
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
7409581901
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$735.80 |
| Max. Negotiated Rate |
$944.48 |
| Rate for Payer: Aetna of VT Commercial |
$944.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$735.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$735.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$845.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$835.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$795.35
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cigna Commercial |
$795.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$795.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$795.35
|
| Rate for Payer: Multiplan Commercial |
$924.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$845.06
|
| Rate for Payer: United Healthcare Commercial |
$944.48
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
9869581901
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna of VT Commercial |
$57.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.80
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$56.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.85
|
| Rate for Payer: United Healthcare Commercial |
$57.95
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
OP
|
$994.19
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
7409581901
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$440.33 |
| Max. Negotiated Rate |
$944.48 |
| Rate for Payer: Aetna of VT Commercial |
$944.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$890.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$440.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$890.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$598.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$845.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$805.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$790.38
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cigna Commercial |
$795.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$795.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$795.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$447.39
|
| Rate for Payer: Multiplan Commercial |
$924.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$845.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$447.39
|
| Rate for Payer: United Healthcare Commercial |
$944.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$447.39
|
| Rate for Payer: United Healthcare VA CCN |
$447.39
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
9869581901
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna of VT Commercial |
$57.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.49
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.45
|
| Rate for Payer: Multiplan Commercial |
$56.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.45
|
| Rate for Payer: United Healthcare Commercial |
$57.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.45
|
| Rate for Payer: United Healthcare VA CCN |
$27.45
|
|
|
EEG AWAKE AND ASLEEP
|
Professional
|
Both
|
$994.19
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
7409581901
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$433.45 |
| Max. Negotiated Rate |
$934.54 |
| Rate for Payer: Aetna of VT Commercial |
$934.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$890.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$446.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$890.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$606.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$553.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$553.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$498.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$553.16
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Cigna Commercial |
$652.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$695.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$695.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$433.45
|
| Rate for Payer: Multiplan Commercial |
$924.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$433.45
|
| Rate for Payer: United Healthcare Commercial |
$666.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$433.45
|
| Rate for Payer: United Healthcare VA CCN |
$433.45
|
|
|
EEG AWAKE AND DROWSY
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
9869581601
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$249.35 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna of VT Commercial |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$249.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$338.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$447.58
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.35
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare VA CCN |
$253.35
|
|
|
EEG AWAKE AND DROWSY
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
9869581601
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$416.68 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna of VT Commercial |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$472.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$450.40
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.40
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.55
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
|
|
EEG AWAKE AND DROWSY
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
9869581601
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$372.25 |
| Max. Negotiated Rate |
$597.62 |
| Rate for Payer: Aetna of VT Commercial |
$529.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$383.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$521.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$470.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$470.39
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$566.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$597.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$597.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$372.25
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$372.25
|
| Rate for Payer: United Healthcare Commercial |
$572.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$372.25
|
| Rate for Payer: United Healthcare VA CCN |
$372.25
|
|
|
EEG AWAKE AND DROWSY
|
Facility
|
OP
|
$560.43
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
7409581601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$248.21 |
| Max. Negotiated Rate |
$532.41 |
| Rate for Payer: Aetna of VT Commercial |
$532.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$248.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$337.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$476.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$453.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$252.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.54
|
| Rate for Payer: Cash Price |
$280.21
|
| Rate for Payer: Cigna Commercial |
$448.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$448.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$448.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$252.19
|
| Rate for Payer: Multiplan Commercial |
$521.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$476.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$252.19
|
| Rate for Payer: United Healthcare Commercial |
$532.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.19
|
| Rate for Payer: United Healthcare VA CCN |
$252.19
|
|
|
EEG AWAKE AND DROWSY
|
Professional
|
Both
|
$560.43
|
|
| Hospital Charge Code |
7409581601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$224.17 |
| Max. Negotiated Rate |
$526.80 |
| Rate for Payer: Aetna of VT Commercial |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.09
|
| Rate for Payer: Cash Price |
$280.21
|
| Rate for Payer: Multiplan Commercial |
$521.20
|
| Rate for Payer: United Healthcare Commercial |
$476.37
|
| Rate for Payer: United Healthcare VA CCN |
$224.17
|
|
|
EEG AWAKE AND DROWSY
|
Facility
|
IP
|
$560.43
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
7409581601
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$414.77 |
| Max. Negotiated Rate |
$532.41 |
| Rate for Payer: Aetna of VT Commercial |
$532.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$414.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$414.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$476.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$448.34
|
| Rate for Payer: Cash Price |
$280.21
|
| Rate for Payer: Cigna Commercial |
$448.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$448.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$448.34
|
| Rate for Payer: Multiplan Commercial |
$521.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$476.37
|
| Rate for Payer: United Healthcare Commercial |
$532.41
|
|
|
EEG EXTEND MON 41-60 MIN
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
9869581201
|
|
Hospital Revenue Code
|
986
|
| Min. Negotiated Rate |
$496.61 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna of VT Commercial |
$637.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$496.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$496.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$570.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$563.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$536.80
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$536.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$536.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$536.80
|
| Rate for Payer: Multiplan Commercial |
$624.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$570.35
|
| Rate for Payer: United Healthcare Commercial |
$637.45
|
|
|
EEG EXTEND MON 41-60 MIN
|
Facility
|
OP
|
$1,172.30
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
7409581201
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$519.21 |
| Max. Negotiated Rate |
$1,113.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,113.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,050.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$519.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,050.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$705.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$996.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$949.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$527.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$931.98
|
| Rate for Payer: Cash Price |
$586.15
|
| Rate for Payer: Cigna Commercial |
$937.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$937.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$937.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$527.53
|
| Rate for Payer: Multiplan Commercial |
$1,090.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$996.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$527.53
|
| Rate for Payer: United Healthcare Commercial |
$1,113.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$527.53
|
| Rate for Payer: United Healthcare VA CCN |
$527.53
|
|
|
EEG EXTEND MON 41-60 MIN
|
Facility
|
IP
|
$1,172.30
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
7409581201
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$867.62 |
| Max. Negotiated Rate |
$1,113.68 |
| Rate for Payer: Aetna of VT Commercial |
$1,113.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$996.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$984.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$937.84
|
| Rate for Payer: Cash Price |
$586.15
|
| Rate for Payer: Cigna Commercial |
$937.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$937.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$937.84
|
| Rate for Payer: Multiplan Commercial |
$1,090.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$996.46
|
| Rate for Payer: United Healthcare Commercial |
$1,113.68
|
|
