|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$815.83
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$603.80 |
| Max. Negotiated Rate |
$775.04 |
| Rate for Payer: Aetna of VT Commercial |
$775.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$693.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$685.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$652.66
|
| Rate for Payer: Cash Price |
$407.92
|
| Rate for Payer: Cigna Commercial |
$652.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.66
|
| Rate for Payer: Multiplan Commercial |
$758.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$693.46
|
| Rate for Payer: United Healthcare Commercial |
$775.04
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 76818 26
|
| Hospital Charge Code |
9727681801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$299.96 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.35
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$72.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.47
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.47
|
| Rate for Payer: United Healthcare Commercial |
$73.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.47
|
| Rate for Payer: United Healthcare VA CCN |
$47.47
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$815.83
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$299.96 |
| Max. Negotiated Rate |
$775.04 |
| Rate for Payer: Aetna of VT Commercial |
$775.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$361.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$491.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$693.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$660.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$367.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$648.58
|
| Rate for Payer: Cash Price |
$407.92
|
| Rate for Payer: Cash Price |
$407.92
|
| Rate for Payer: Cigna Commercial |
$652.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$652.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$652.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$367.12
|
| Rate for Payer: Multiplan Commercial |
$758.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$693.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$367.12
|
| Rate for Payer: United Healthcare Commercial |
$775.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.12
|
| Rate for Payer: United Healthcare VA CCN |
$367.12
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 76818 26
|
| Hospital Charge Code |
9727681801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 76818 26
|
| Hospital Charge Code |
9727681801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 76819 26
|
| Hospital Charge Code |
9727681901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.04
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare VA CCN |
$50.40
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 76819 26
|
| Hospital Charge Code |
9727681901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$82.89 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
OP
|
$672.88
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$639.24 |
| Rate for Payer: Aetna of VT Commercial |
$639.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$571.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$302.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$534.94
|
| Rate for Payer: Cash Price |
$336.44
|
| Rate for Payer: Cash Price |
$336.44
|
| Rate for Payer: Cigna Commercial |
$538.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$302.80
|
| Rate for Payer: Multiplan Commercial |
$625.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$302.80
|
| Rate for Payer: United Healthcare Commercial |
$639.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.80
|
| Rate for Payer: United Healthcare VA CCN |
$302.80
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
IP
|
$672.88
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$639.24 |
| Rate for Payer: Aetna of VT Commercial |
$639.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$571.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$565.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$538.30
|
| Rate for Payer: Cash Price |
$336.44
|
| Rate for Payer: Cigna Commercial |
$538.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.30
|
| Rate for Payer: Multiplan Commercial |
$625.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$571.95
|
| Rate for Payer: United Healthcare Commercial |
$639.24
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 76819 26
|
| Hospital Charge Code |
9727681901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna of VT Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.09
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$52.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.55
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.56
|
| Rate for Payer: United Healthcare Commercial |
$53.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.56
|
| Rate for Payer: United Healthcare VA CCN |
$34.56
|
|
|
FETAL CONTRACT STRESS TEST
|
Facility
|
IP
|
$439.04
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
7205902001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$324.93 |
| Max. Negotiated Rate |
$417.09 |
| Rate for Payer: Aetna of VT Commercial |
$417.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.23
|
| Rate for Payer: Cash Price |
$219.52
|
| Rate for Payer: Cigna Commercial |
$351.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.23
|
| Rate for Payer: Multiplan Commercial |
$408.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.18
|
| Rate for Payer: United Healthcare Commercial |
$417.09
|
|
|
FETAL CONTRACT STRESS TEST
|
Facility
|
OP
|
$439.04
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
7205902001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.45 |
| Max. Negotiated Rate |
$417.09 |
| Rate for Payer: Aetna of VT Commercial |
$417.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$393.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$393.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.04
|
| Rate for Payer: Cash Price |
$219.52
|
| Rate for Payer: Cigna Commercial |
$351.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.57
|
| Rate for Payer: Multiplan Commercial |
$408.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.57
|
| Rate for Payer: United Healthcare Commercial |
$417.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.57
|
| Rate for Payer: United Healthcare VA CCN |
$197.57
|
|
|
FETAL MONITOR W/REPORT
|
Facility
|
OP
|
$277.53
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
7205905001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$263.65 |
| Rate for Payer: Aetna of VT Commercial |
$263.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.64
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Commercial |
$222.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.89
|
| Rate for Payer: Multiplan Commercial |
$258.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.89
|
| Rate for Payer: United Healthcare Commercial |
$263.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.89
|
| Rate for Payer: United Healthcare VA CCN |
$124.89
|
|
|
FETAL MONITOR W/REPORT
|
Facility
|
IP
|
$277.53
|
|
|
Service Code
|
CPT 59050
|
| Hospital Charge Code |
7205905001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$263.65 |
| Rate for Payer: Aetna of VT Commercial |
$263.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.02
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Commercial |
$222.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.02
|
| Rate for Payer: Multiplan Commercial |
$258.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.90
|
| Rate for Payer: United Healthcare Commercial |
$263.65
|
|
|
FETAL NON-STRESS TEST
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$683.38 |
| Rate for Payer: Aetna of VT Commercial |
$683.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$651.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$651.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.99
|
| Rate for Payer: Cash Price |
$363.50
|
| Rate for Payer: Cash Price |
$363.50
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.35
|
| Rate for Payer: Multiplan Commercial |
$676.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare Commercial |
$70.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare VA CCN |
$45.51
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.99 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Aetna of VT Commercial |
$690.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$651.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$321.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$651.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$437.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$617.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$588.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$327.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$577.97
|
| Rate for Payer: Cash Price |
$363.50
|
| Rate for Payer: Cigna Commercial |
$581.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$581.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$581.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$327.15
|
| Rate for Payer: Multiplan Commercial |
$676.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$617.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$327.15
|
| Rate for Payer: United Healthcare Commercial |
$690.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.15
|
| Rate for Payer: United Healthcare VA CCN |
$327.15
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$538.05 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Aetna of VT Commercial |
$690.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$617.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$610.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$581.60
|
| Rate for Payer: Cash Price |
$363.50
|
| Rate for Payer: Cigna Commercial |
$581.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$581.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$581.60
|
| Rate for Payer: Multiplan Commercial |
$676.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$617.95
|
| Rate for Payer: United Healthcare Commercial |
$690.65
|
|
|
FETAL NON-STRESS TEST
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Aetna of VT Commercial |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.99
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.35
|
| Rate for Payer: Multiplan Commercial |
$237.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare Commercial |
$70.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare VA CCN |
$45.51
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9815902502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
FETAL NON-STRESS TEST
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
5105902501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$444.62 |
| Rate for Payer: Aetna of VT Commercial |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.99
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.35
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare Commercial |
$70.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.51
|
| Rate for Payer: United Healthcare VA CCN |
$45.51
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$472.54
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$349.73 |
| Max. Negotiated Rate |
$448.91 |
| Rate for Payer: Aetna of VT Commercial |
$448.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$401.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.03
|
| Rate for Payer: Cash Price |
$236.27
|
| Rate for Payer: Cigna Commercial |
$378.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.03
|
| Rate for Payer: Multiplan Commercial |
$439.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$401.66
|
| Rate for Payer: United Healthcare Commercial |
$448.91
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
5105902501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.49 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna of VT Commercial |
$449.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$284.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.04
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.85
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare Commercial |
$449.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare VA CCN |
$212.85
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna of VT Commercial |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$202.72
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$237.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$216.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.75
|
| Rate for Payer: United Healthcare VA CCN |
$114.75
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
9605902502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.73 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna of VT Commercial |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$216.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$204.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$237.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$216.75
|
| Rate for Payer: United Healthcare Commercial |
$242.25
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$846.73
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
4505902501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.02 |
| Max. Negotiated Rate |
$804.39 |
| Rate for Payer: Aetna of VT Commercial |
$804.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$758.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$375.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$758.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$509.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$685.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$381.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$673.15
|
| Rate for Payer: Cash Price |
$423.36
|
| Rate for Payer: Cigna Commercial |
$677.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.03
|
| Rate for Payer: Multiplan Commercial |
$787.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.03
|
| Rate for Payer: United Healthcare Commercial |
$804.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.03
|
| Rate for Payer: United Healthcare VA CCN |
$381.03
|
|
