|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$47.56
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
9409703201
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna of VT Commercial |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.05
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.05
|
| Rate for Payer: Multiplan Commercial |
$44.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.43
|
| Rate for Payer: United Healthcare Commercial |
$45.18
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
4309703201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
4209703201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
OP
|
$47.56
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
9409703201
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Aetna of VT Commercial |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.81
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cigna Commercial |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.40
|
| Rate for Payer: Multiplan Commercial |
$44.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.40
|
| Rate for Payer: United Healthcare Commercial |
$45.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.40
|
| Rate for Payer: United Healthcare VA CCN |
$21.40
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
4309703201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
4209703201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
ELECTRIC CURRENT THERAPY
|
Facility
|
OP
|
$107.79
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
4309703301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna of VT Commercial |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.69
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna Commercial |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.51
|
| Rate for Payer: Multiplan Commercial |
$100.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.51
|
| Rate for Payer: United Healthcare Commercial |
$102.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.51
|
| Rate for Payer: United Healthcare VA CCN |
$48.51
|
|
|
ELECTRIC CURRENT THERAPY
|
Facility
|
IP
|
$107.79
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
4309703301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna of VT Commercial |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.23
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna Commercial |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$100.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.62
|
| Rate for Payer: United Healthcare Commercial |
$102.40
|
|
|
ELECTRIC CURRENT THERAPY
|
Facility
|
OP
|
$107.79
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
4209703301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna of VT Commercial |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.69
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna Commercial |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.51
|
| Rate for Payer: Multiplan Commercial |
$100.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.51
|
| Rate for Payer: United Healthcare Commercial |
$102.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.51
|
| Rate for Payer: United Healthcare VA CCN |
$48.51
|
|
|
ELECTRIC CURRENT THERAPY
|
Facility
|
IP
|
$107.79
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
4209703301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna of VT Commercial |
$102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.23
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna Commercial |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.23
|
| Rate for Payer: Multiplan Commercial |
$100.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.62
|
| Rate for Payer: United Healthcare Commercial |
$102.40
|
|
|
ELECTRIC STIMULATION THERAPY
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
CPT 97014 GO
|
| Hospital Charge Code |
4309701401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.98
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.88
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.88
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.88
|
| Rate for Payer: United Healthcare VA CCN |
$41.88
|
|
|
ELECTRIC STIMULATION THERAPY
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
CPT 97014 GO
|
| Hospital Charge Code |
4309701401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.45
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
|
|
ELECTRIC STIMULATION THERAPY
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
4209701401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.98
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.88
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.88
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.88
|
| Rate for Payer: United Healthcare VA CCN |
$41.88
|
|
|
ELECTRIC STIMULATION THERAPY
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
4209701401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$88.41 |
| Rate for Payer: Aetna of VT Commercial |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.45
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.45
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$88.41
|
|
|
ELECTRIC STIMULATION THERAPY
|
Professional
|
Both
|
$93.06
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
4209701401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Aetna of VT Commercial |
$87.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.57
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: Cigna Commercial |
$14.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$86.55
|
| Rate for Payer: United Healthcare Commercial |
$79.10
|
| Rate for Payer: United Healthcare VA CCN |
$12.42
|
|
|
ELECTROCARDIOGRAM COMPLETE
|
Facility
|
OP
|
$226.93
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
7309300001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$100.51 |
| Max. Negotiated Rate |
$215.58 |
| Rate for Payer: Aetna of VT Commercial |
$215.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.41
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cigna Commercial |
$181.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$211.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.12
|
| Rate for Payer: United Healthcare Commercial |
$215.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.12
|
| Rate for Payer: United Healthcare VA CCN |
$102.12
|
|
|
ELECTROCARDIOGRAM COMPLETE
|
Professional
|
Both
|
$77.55
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
7309300001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna of VT Commercial |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.16
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$37.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$20.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare VA CCN |
$13.54
|
|
|
ELECTROCARDIOGRAM COMPLETE
|
Facility
|
IP
|
$226.93
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
7309300001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$167.95 |
| Max. Negotiated Rate |
$215.58 |
| Rate for Payer: Aetna of VT Commercial |
$215.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$167.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$167.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$192.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.54
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cigna Commercial |
$181.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.54
|
| Rate for Payer: Multiplan Commercial |
$211.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.89
|
| Rate for Payer: United Healthcare Commercial |
$215.58
|
|
|
ELECTROLYTE PANEL
|
Facility
|
IP
|
$84.15
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
3008005101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$79.94 |
| Rate for Payer: Aetna of VT Commercial |
$79.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.32
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cigna Commercial |
$67.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.32
|
| Rate for Payer: Multiplan Commercial |
$78.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.53
|
| Rate for Payer: United Healthcare Commercial |
$79.94
|
|
|
ELECTROLYTE PANEL
|
Facility
|
OP
|
$84.15
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
3008005101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$79.94 |
| Rate for Payer: Aetna of VT Commercial |
$79.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.90
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cigna Commercial |
$67.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.87
|
| Rate for Payer: Multiplan Commercial |
$78.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.87
|
| Rate for Payer: United Healthcare Commercial |
$79.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.01
|
| Rate for Payer: United Healthcare VA CCN |
$37.87
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna of VT Commercial |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.80
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$117.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$119.70
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9605174101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$297.04 |
| Rate for Payer: Aetna of VT Commercial |
$297.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.84
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$23.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$293.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$20.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare VA CCN |
$13.39
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9605174102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.80
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9825174101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.84
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.95
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.95
|
| Rate for Payer: United Healthcare VA CCN |
$85.95
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
9825174101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna of VT Commercial |
$181.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.80
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$177.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.35
|
| Rate for Payer: United Healthcare Commercial |
$181.45
|
|
