|
EXPLORE WOUND NECK
|
Professional
|
Both
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.72 |
| Max. Negotiated Rate |
$1,575.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,575.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$566.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$769.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$632.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,056.46
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,043.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$549.72
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare Commercial |
$845.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare VA CCN |
$549.73
|
|
|
EXPLORE WOUND NECK
|
Professional
|
Both
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.72 |
| Max. Negotiated Rate |
$1,575.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,575.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$566.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$769.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$632.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,056.46
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,043.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$549.72
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare Commercial |
$845.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare VA CCN |
$549.73
|
|
|
EXPLORE WOUND NECK
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,240.41 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,407.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,340.80
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
|
|
EXPLORE WOUND NECK
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9812010002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,240.41 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,407.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,340.80
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
|
|
EXPLORE WOUND SPX NECK
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9822010001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$742.30 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$742.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,008.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,357.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$754.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,332.42
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$754.20
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$754.20
|
| Rate for Payer: United Healthcare VA CCN |
$754.20
|
|
|
EXPLORE WOUND SPX NECK
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9822010001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,240.41 |
| Max. Negotiated Rate |
$1,592.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,240.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,407.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,340.80
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,340.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,424.60
|
| Rate for Payer: United Healthcare Commercial |
$1,592.20
|
|
|
EXPLORE WOUND SPX NECK
|
Professional
|
Both
|
$1,676.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
9822010001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$549.72 |
| Max. Negotiated Rate |
$1,575.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,575.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$566.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,501.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$769.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$632.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,056.46
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,043.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$929.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$929.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$549.72
|
| Rate for Payer: Multiplan Commercial |
$1,558.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$780.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare Commercial |
$845.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.73
|
| Rate for Payer: United Healthcare VA CCN |
$549.73
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9825941201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$419.24 |
| Rate for Payer: Aetna of VT Commercial |
$419.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.34
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$100.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.61
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.65
|
| Rate for Payer: United Healthcare Commercial |
$140.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.65
|
| Rate for Payer: United Healthcare VA CCN |
$91.65
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9825941201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.57
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.70
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare VA CCN |
$200.70
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9825941201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.80
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9695941201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.80
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9695941201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$419.24 |
| Rate for Payer: Aetna of VT Commercial |
$419.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.34
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$100.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.61
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.65
|
| Rate for Payer: United Healthcare Commercial |
$140.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.65
|
| Rate for Payer: United Healthcare VA CCN |
$91.65
|
|
|
EXT CEPHAL VERS W/WO TOCOLYSIS
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
9695941201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.57
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.70
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare VA CCN |
$200.70
|
|
|
EXT CEPHA VER W/WO TOCOL 52MOD
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 59412 59
|
| Hospital Charge Code |
9695941202
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$268.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.57
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.70
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.70
|
| Rate for Payer: United Healthcare VA CCN |
$200.70
|
|
|
EXT CEPHA VER W/WO TOCOL 52MOD
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 59412 59
|
| Hospital Charge Code |
9695941202
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna of VT Commercial |
$423.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$374.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.80
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$356.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$356.80
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.10
|
| Rate for Payer: United Healthcare Commercial |
$423.70
|
|
|
EXT CEPHA VER W/WO TOCOL 52MOD
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 59412 59
|
| Hospital Charge Code |
9695941202
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$419.24 |
| Rate for Payer: Aetna of VT Commercial |
$419.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.34
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$100.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.61
|
| Rate for Payer: Multiplan Commercial |
$414.78
|
| Rate for Payer: United Healthcare Commercial |
$379.10
|
| Rate for Payer: United Healthcare VA CCN |
$178.40
|
|
|
EXT ECG>48HR<7D RECORDING
|
Facility
|
OP
|
$125.17
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$118.91 |
| Rate for Payer: Aetna of VT Commercial |
$118.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.51
|
| Rate for Payer: Cash Price |
$62.58
|
| Rate for Payer: Cigna Commercial |
$100.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.33
|
| Rate for Payer: Multiplan Commercial |
$116.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.33
|
| Rate for Payer: United Healthcare Commercial |
$118.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.33
|
| Rate for Payer: United Healthcare VA CCN |
$56.33
|
|
|
EXT ECG>48HR<7D RECORDING
|
Facility
|
IP
|
$125.17
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$118.91 |
| Rate for Payer: Aetna of VT Commercial |
$118.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.14
|
| Rate for Payer: Cash Price |
$62.58
|
| Rate for Payer: Cigna Commercial |
$100.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.14
|
| Rate for Payer: Multiplan Commercial |
$116.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.39
|
| Rate for Payer: United Healthcare Commercial |
$118.91
|
|
|
EXT ECG>48HR<7D REV&INTERPJ
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
9859324401
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$78.02 |
| Rate for Payer: Aetna of VT Commercial |
$78.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.40
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$55.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.91
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.91
|
| Rate for Payer: United Healthcare Commercial |
$36.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.91
|
| Rate for Payer: United Healthcare VA CCN |
$23.91
|
|
|
EXT ECG>48HR<7D REV&INTERPJ
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 93244
|
| Hospital Charge Code |
9859324401
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of VT Commercial |
$78.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.40
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.55
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
|
|
EXT ECG>48HR<7D REV&INTERPJ
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 93244
|
| Hospital Charge Code |
9859324401
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of VT Commercial |
$78.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.98
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.35
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare VA CCN |
$37.35
|
|
|
EXT ECG>7D<15D RECORDING
|
Professional
|
Both
|
$172.66
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
7309324601
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: Aetna of VT Commercial |
$162.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.45
|
| Rate for Payer: Cash Price |
$86.33
|
| Rate for Payer: Cash Price |
$86.33
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$160.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.09
|
| Rate for Payer: United Healthcare Commercial |
$17.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.09
|
| Rate for Payer: United Healthcare VA CCN |
$11.09
|
|
|
EXT ECG>7D<15D RECORDING
|
Facility
|
IP
|
$172.66
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
7309324601
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$127.79 |
| Max. Negotiated Rate |
$164.03 |
| Rate for Payer: Aetna of VT Commercial |
$164.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.13
|
| Rate for Payer: Cash Price |
$86.33
|
| Rate for Payer: Cigna Commercial |
$138.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.13
|
| Rate for Payer: Multiplan Commercial |
$160.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.76
|
| Rate for Payer: United Healthcare Commercial |
$164.03
|
|
|
EXT ECG>7D<15D RECORDING
|
Facility
|
OP
|
$172.66
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
7309324601
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$164.03 |
| Rate for Payer: Aetna of VT Commercial |
$164.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.26
|
| Rate for Payer: Cash Price |
$86.33
|
| Rate for Payer: Cigna Commercial |
$138.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$160.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.70
|
| Rate for Payer: United Healthcare Commercial |
$164.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.70
|
| Rate for Payer: United Healthcare VA CCN |
$77.70
|
|
|
EXT ECG>7D<15D REV&INTERPJ
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
9859324801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of VT Commercial |
$78.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.40
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.55
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
|
