|
FLUID PRESSURE MUSCLE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$697.48 |
| Rate for Payer: Aetna of VT Commercial |
$697.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.70
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$157.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare VA CCN |
$83.15
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.15 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9822095001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$549.15 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$328.63 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$328.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$446.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$601.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$589.89
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$333.90
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.90
|
| Rate for Payer: United Healthcare VA CCN |
$333.90
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$549.15 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna of VT Commercial |
$704.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$630.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$623.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.60
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$593.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$593.60
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$704.90
|
|
|
FLUID PRESSURE MUSCLE
|
Facility
|
IP
|
$816.65
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
4502095001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$604.40 |
| Max. Negotiated Rate |
$775.82 |
| Rate for Payer: Aetna of VT Commercial |
$775.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$604.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$604.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$694.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$685.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$653.32
|
| Rate for Payer: Cash Price |
$408.32
|
| Rate for Payer: Cigna Commercial |
$653.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$653.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$653.32
|
| Rate for Payer: Multiplan Commercial |
$759.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$694.15
|
| Rate for Payer: United Healthcare Commercial |
$775.82
|
|
|
FLUID PRESSURE MUSCLE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9822095001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$697.48 |
| Rate for Payer: Aetna of VT Commercial |
$697.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.70
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$157.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare VA CCN |
$83.15
|
|
|
FLUID PRESSURE MUSCLE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
9812095001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$697.48 |
| Rate for Payer: Aetna of VT Commercial |
$697.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$664.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$384.70
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$157.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$396.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$396.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$690.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.15
|
| Rate for Payer: United Healthcare VA CCN |
$83.15
|
|
|
FLUORESCEIN EYE STRIPS
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 1723890011
|
| Hospital Charge Code |
2500000123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
FLUORESCEIN EYE STRIPS
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
FLUORESCENT ANTIBODY SCREEN
|
Professional
|
Both
|
$195.57
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
3008625501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna of VT Commercial |
$183.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.32
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$35.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
FLUORESCENT ANTIBODY SCREEN
|
Facility
|
OP
|
$195.57
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
3008625501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$185.79 |
| Rate for Payer: Aetna of VT Commercial |
$185.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.48
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.01
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.01
|
| Rate for Payer: United Healthcare Commercial |
$185.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$88.01
|
|
|
FLUORESCENT ANTIBODY SCREEN
|
Facility
|
IP
|
$195.57
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
3008625501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$185.79 |
| Rate for Payer: Aetna of VT Commercial |
$185.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.46
|
| Rate for Payer: Cash Price |
$97.78
|
| Rate for Payer: Cigna Commercial |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.46
|
| Rate for Payer: Multiplan Commercial |
$181.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.23
|
| Rate for Payer: United Healthcare Commercial |
$185.79
|
|
|
FLUORESCENT ANTIBODY TITER
|
Professional
|
Both
|
$200.71
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
3008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$188.67 |
| Rate for Payer: Aetna of VT Commercial |
$188.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.32
|
| Rate for Payer: Cash Price |
$100.36
|
| Rate for Payer: Cash Price |
$100.36
|
| Rate for Payer: Cigna Commercial |
$35.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$186.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
FLUORESCENT ANTIBODY TITER
|
Facility
|
IP
|
$200.71
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
3008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.55 |
| Max. Negotiated Rate |
$190.67 |
| Rate for Payer: Aetna of VT Commercial |
$190.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.57
|
| Rate for Payer: Cash Price |
$100.36
|
| Rate for Payer: Cigna Commercial |
$160.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.57
|
| Rate for Payer: Multiplan Commercial |
$186.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.60
|
| Rate for Payer: United Healthcare Commercial |
$190.67
|
|
|
FLUORESCENT ANTIBODY TITER
|
Facility
|
OP
|
$200.71
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
3008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$190.67 |
| Rate for Payer: Aetna of VT Commercial |
$190.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.56
|
| Rate for Payer: Cash Price |
$100.36
|
| Rate for Payer: Cash Price |
$100.36
|
| Rate for Payer: Cigna Commercial |
$160.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.32
|
| Rate for Payer: Multiplan Commercial |
$186.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.32
|
| Rate for Payer: United Healthcare Commercial |
$190.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$90.32
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
OP
|
$1,005.05
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
3207700301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$333.59 |
| Max. Negotiated Rate |
$954.80 |
| Rate for Payer: Aetna of VT Commercial |
$954.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$333.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$445.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$333.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$605.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$854.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$814.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$452.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$799.01
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Cigna Commercial |
$804.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$804.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$804.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$452.27
|
| Rate for Payer: Multiplan Commercial |
$934.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$854.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$452.27
|
| Rate for Payer: United Healthcare Commercial |
$954.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$452.27
|
| Rate for Payer: United Healthcare VA CCN |
$452.27
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
9727700301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna of VT Commercial |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.25
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare VA CCN |
$67.50
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
9727700301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna of VT Commercial |
$142.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: United Healthcare Commercial |
$142.50
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
IP
|
$1,005.05
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
3207700301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$743.84 |
| Max. Negotiated Rate |
$954.80 |
| Rate for Payer: Aetna of VT Commercial |
$954.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$743.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$743.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$854.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$844.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$804.04
|
| Rate for Payer: Cash Price |
$502.52
|
| Rate for Payer: Cigna Commercial |
$804.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$804.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$804.04
|
| Rate for Payer: Multiplan Commercial |
$934.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$854.29
|
| Rate for Payer: United Healthcare Commercial |
$954.80
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727700301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna of VT Commercial |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
FLUOROGUIDE FOR VEIN DEVICE
|
Facility
|
OP
|
$1,046.41
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3207700101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.92 |
| Max. Negotiated Rate |
$994.09 |
| Rate for Payer: Aetna of VT Commercial |
$994.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$463.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$629.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$889.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$847.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$470.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.90
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cigna Commercial |
$837.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$837.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$837.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$470.88
|
| Rate for Payer: Multiplan Commercial |
$973.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$889.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$470.88
|
| Rate for Payer: United Healthcare Commercial |
$994.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.88
|
| Rate for Payer: United Healthcare VA CCN |
$470.88
|
|
|
FLUOROGUIDE FOR VEIN DEVICE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
9727700101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna of VT Commercial |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.28
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.35
|
| Rate for Payer: Multiplan Commercial |
$207.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.35
|
| Rate for Payer: United Healthcare Commercial |
$211.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.35
|
| Rate for Payer: United Healthcare VA CCN |
$100.35
|
|
|
FLUOROGUIDE FOR VEIN DEVICE
|
Facility
|
IP
|
$1,046.41
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3207700101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$774.45 |
| Max. Negotiated Rate |
$994.09 |
| Rate for Payer: Aetna of VT Commercial |
$994.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$774.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$774.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$889.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$878.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$837.13
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cigna Commercial |
$837.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$837.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$837.13
|
| Rate for Payer: Multiplan Commercial |
$973.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$889.45
|
| Rate for Payer: United Healthcare Commercial |
$994.09
|
|
|
FLUOROGUIDE FOR VEIN DEVICE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
9727700101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$165.04 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna of VT Commercial |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.40
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.40
|
| Rate for Payer: Multiplan Commercial |
$207.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.55
|
| Rate for Payer: United Healthcare Commercial |
$211.85
|
|
