|
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
|
|
|
EXT ECG>7D<15D REV&INTERPJ
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
9859324801
|
|
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
|
|
|
EXTENSIVE HYSTERECTOMY
|
Professional
|
Both
|
$3,965.00
|
|
|
Service Code
|
CPT 58200
|
| Hospital Charge Code |
9825820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,254.17 |
| Max. Negotiated Rate |
$3,727.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,727.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,552.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,291.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,552.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,755.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,183.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,183.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,442.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,183.62
|
| Rate for Payer: Cash Price |
$1,982.50
|
| Rate for Payer: Cash Price |
$1,982.50
|
| Rate for Payer: Cigna Commercial |
$2,205.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,094.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,094.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,254.17
|
| Rate for Payer: Multiplan Commercial |
$3,687.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,780.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,254.17
|
| Rate for Payer: United Healthcare Commercial |
$1,929.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,254.17
|
| Rate for Payer: United Healthcare VA CCN |
$1,254.17
|
|
|
EXTENSIVE HYSTERECTOMY
|
Facility
|
OP
|
$3,965.00
|
|
|
Service Code
|
CPT 58200
|
| Hospital Charge Code |
9825820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,756.10 |
| Max. Negotiated Rate |
$3,766.75 |
| Rate for Payer: Aetna of VT Commercial |
$3,766.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,552.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,756.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,552.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,386.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,370.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,784.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,152.18
|
| Rate for Payer: Cash Price |
$1,982.50
|
| Rate for Payer: Cigna Commercial |
$3,172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,172.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,784.25
|
| Rate for Payer: Multiplan Commercial |
$3,687.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,370.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,784.25
|
| Rate for Payer: United Healthcare Commercial |
$3,766.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,784.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,784.25
|
|
|
EXTENSIVE HYSTERECTOMY
|
Facility
|
IP
|
$3,965.00
|
|
|
Service Code
|
CPT 58200
|
| Hospital Charge Code |
9825820001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,934.50 |
| Max. Negotiated Rate |
$3,766.75 |
| Rate for Payer: Aetna of VT Commercial |
$3,766.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,934.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,934.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,370.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,330.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,172.00
|
| Rate for Payer: Cash Price |
$1,982.50
|
| Rate for Payer: Cigna Commercial |
$3,172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,172.00
|
| Rate for Payer: Multiplan Commercial |
$3,687.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,370.25
|
| Rate for Payer: United Healthcare Commercial |
$3,766.75
|
|
|
EXTREMITY STUDY
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9609397001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$726.54 |
| Rate for Payer: Aetna of VT Commercial |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$726.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$181.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$726.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$303.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$303.47
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$213.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$176.56
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.55
|
| Rate for Payer: United Healthcare Commercial |
$271.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.55
|
| Rate for Payer: United Healthcare VA CCN |
$176.55
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9609397001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.32
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.20
|
| Rate for Payer: United Healthcare VA CCN |
$43.20
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$1,324.55
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9209397001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$586.64 |
| Max. Negotiated Rate |
$1,258.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$586.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$797.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,125.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,072.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$596.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.02
|
| Rate for Payer: Cash Price |
$662.28
|
| Rate for Payer: Cigna Commercial |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,059.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$596.05
|
| Rate for Payer: Multiplan Commercial |
$1,231.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,125.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$596.05
|
| Rate for Payer: United Healthcare Commercial |
$1,258.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$596.05
|
| Rate for Payer: United Healthcare VA CCN |
$596.05
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$1,324.55
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9209397001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$980.30 |
| Max. Negotiated Rate |
$1,258.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,125.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,112.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,059.64
|
| Rate for Payer: Cash Price |
$662.28
|
| Rate for Payer: Cigna Commercial |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,059.64
|
| Rate for Payer: Multiplan Commercial |
$1,231.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,125.87
|
| Rate for Payer: United Healthcare Commercial |
$1,258.32
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$268.66 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Aetna of VT Commercial |
$344.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$268.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$268.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$290.40
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$290.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$290.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$290.40
|
| Rate for Payer: Multiplan Commercial |
$337.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$308.55
|
| Rate for Payer: United Healthcare Commercial |
$344.85
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9609397001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$89.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.60
|
| Rate for Payer: United Healthcare Commercial |
$91.20
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$886.14
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9219397101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$655.83 |
| Max. Negotiated Rate |
$841.83 |
| Rate for Payer: Aetna of VT Commercial |
$841.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$744.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$708.91
|
| Rate for Payer: Cash Price |
$443.07
|
| Rate for Payer: Cigna Commercial |
$708.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.91
|
| Rate for Payer: Multiplan Commercial |
$824.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.22
|
| Rate for Payer: United Healthcare Commercial |
$841.83
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397101
|
|
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
|
|
|
EXTREMITY STUDY
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$450.69 |
| Rate for Payer: Aetna of VT Commercial |
$341.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$450.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$450.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.72
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$135.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$337.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$113.04
|
| Rate for Payer: United Healthcare Commercial |
$173.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.04
|
| Rate for Payer: United Healthcare VA CCN |
$113.04
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$711.39
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
4509397101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$526.50 |
| Max. Negotiated Rate |
$675.82 |
| Rate for Payer: Aetna of VT Commercial |
$675.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$526.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$526.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$604.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$597.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$569.11
|
| Rate for Payer: Cash Price |
$355.70
|
| Rate for Payer: Cigna Commercial |
$569.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.11
|
| Rate for Payer: Multiplan Commercial |
$661.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.68
|
| Rate for Payer: United Healthcare Commercial |
$675.82
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Aetna of VT Commercial |
$344.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.58
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$290.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$290.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$290.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.35
|
| Rate for Payer: Multiplan Commercial |
$337.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$308.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$163.35
|
| Rate for Payer: United Healthcare Commercial |
$344.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.35
|
| Rate for Payer: United Healthcare VA CCN |
$163.35
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$1,324.55
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9219397001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$586.64 |
| Max. Negotiated Rate |
$1,258.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$586.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,186.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$797.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,125.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,072.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$596.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.02
|
| Rate for Payer: Cash Price |
$662.28
|
| Rate for Payer: Cigna Commercial |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,059.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$596.05
|
| Rate for Payer: Multiplan Commercial |
$1,231.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,125.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$596.05
|
| Rate for Payer: United Healthcare Commercial |
$1,258.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$596.05
|
| Rate for Payer: United Healthcare VA CCN |
$596.05
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$886.14
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9219397101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$392.47 |
| Max. Negotiated Rate |
$841.83 |
| Rate for Payer: Aetna of VT Commercial |
$841.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$793.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$392.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$793.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$533.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$753.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$717.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$398.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.48
|
| Rate for Payer: Cash Price |
$443.07
|
| Rate for Payer: Cigna Commercial |
$708.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$708.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$708.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.76
|
| Rate for Payer: Multiplan Commercial |
$824.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$753.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.76
|
| Rate for Payer: United Healthcare Commercial |
$841.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.76
|
| Rate for Payer: United Healthcare VA CCN |
$398.76
|
|
|
EXTREMITY STUDY
|
Facility
|
IP
|
$1,324.55
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
9219397001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$980.30 |
| Max. Negotiated Rate |
$1,258.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,125.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,112.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,059.64
|
| Rate for Payer: Cash Price |
$662.28
|
| Rate for Payer: Cigna Commercial |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,059.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,059.64
|
| Rate for Payer: Multiplan Commercial |
$1,231.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,125.87
|
| Rate for Payer: United Healthcare Commercial |
$1,258.32
|
|
|
EXTREMITY STUDY
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$450.69 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$450.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$450.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.72
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$135.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$182.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$182.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$113.04
|
| Rate for Payer: United Healthcare Commercial |
$173.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.04
|
| Rate for Payer: United Healthcare VA CCN |
$113.04
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9819397101
|
|
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
|
|
|
EXTREMITY STUDY
|
Facility
|
OP
|
$711.39
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
4509397101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$675.82 |
| Rate for Payer: Aetna of VT Commercial |
$675.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$637.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$315.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$637.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$428.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$604.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$576.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$320.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$565.56
|
| Rate for Payer: Cash Price |
$355.70
|
| Rate for Payer: Cigna Commercial |
$569.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$569.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$569.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.13
|
| Rate for Payer: Multiplan Commercial |
$661.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$604.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$320.13
|
| Rate for Payer: United Healthcare Commercial |
$675.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.13
|
| Rate for Payer: United Healthcare VA CCN |
$320.13
|
|
|
F2 GENE
|
Facility
|
OP
|
$405.33
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
3008124001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Aetna of VT Commercial |
$385.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$179.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$244.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$344.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$322.24
|
| Rate for Payer: Cash Price |
$202.66
|
| Rate for Payer: Cash Price |
$202.66
|
| Rate for Payer: Cigna Commercial |
$324.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$324.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$324.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.40
|
| Rate for Payer: Multiplan Commercial |
$376.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$344.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.40
|
| Rate for Payer: United Healthcare Commercial |
$385.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare VA CCN |
$182.40
|
|
|
F2 GENE
|
Facility
|
IP
|
$405.33
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
3008124001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$299.98 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Aetna of VT Commercial |
$385.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$344.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$340.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.26
|
| Rate for Payer: Cash Price |
$202.66
|
| Rate for Payer: Cigna Commercial |
$324.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$324.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$324.26
|
| Rate for Payer: Multiplan Commercial |
$376.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$344.53
|
| Rate for Payer: United Healthcare Commercial |
$385.06
|
|
|
F2 GENE
|
Professional
|
Both
|
$405.33
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
3008124001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$381.01 |
| Rate for Payer: Aetna of VT Commercial |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.79
|
| Rate for Payer: Cash Price |
$202.66
|
| Rate for Payer: Cash Price |
$202.66
|
| Rate for Payer: Cigna Commercial |
$79.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.77
|
| Rate for Payer: Multiplan Commercial |
$376.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare Commercial |
$101.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare VA CCN |
$65.69
|
|
