|
INTERROG DEVICE EVAL HEART
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.20
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
INTERROG DEVICE EVAL HEART
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna of VT Commercial |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$268.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$268.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.51
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$158.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.65
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare Commercial |
$104.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.65
|
| Rate for Payer: United Healthcare VA CCN |
$67.65
|
|
|
INTERROG DEVICE EVAL HEART
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
9609328901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$132.87 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of VT Commercial |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$268.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$268.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$238.50
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$240.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$285.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.00
|
| Rate for Payer: United Healthcare VA CCN |
$135.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.11 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.46
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$124.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.11
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare VA CCN |
$53.11
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328801
|
|
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
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$60.48
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna of VT Commercial |
$57.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.08
|
| Rate for Payer: Cash Price |
$30.24
|
| Rate for Payer: Cigna Commercial |
$48.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.22
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare Commercial |
$57.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare VA CCN |
$27.22
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$60.48
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$44.76 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna of VT Commercial |
$57.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.38
|
| Rate for Payer: Cash Price |
$30.24
|
| Rate for Payer: Cigna Commercial |
$48.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.38
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.41
|
| Rate for Payer: United Healthcare Commercial |
$57.46
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
5109328801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna of VT Commercial |
$57.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.49
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.45
|
| Rate for Payer: Multiplan Commercial |
$56.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.45
|
| Rate for Payer: United Healthcare Commercial |
$57.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.45
|
| Rate for Payer: United Healthcare VA CCN |
$27.45
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
5109328801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.11 |
| Max. Negotiated Rate |
$124.35 |
| Rate for Payer: Aetna of VT Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.46
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$124.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.11
|
| Rate for Payer: Multiplan Commercial |
$56.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare VA CCN |
$53.11
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
5109328801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna of VT Commercial |
$57.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.80
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$48.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$56.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.85
|
| Rate for Payer: United Healthcare Commercial |
$57.95
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328801
|
|
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
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
OP
|
$80.65
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4509328801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of VT Commercial |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.12
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna Commercial |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.29
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.29
|
| Rate for Payer: United Healthcare Commercial |
$76.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.29
|
| Rate for Payer: United Healthcare VA CCN |
$36.29
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$80.65
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4509328801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of VT Commercial |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.52
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna Commercial |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.52
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.55
|
| Rate for Payer: United Healthcare Commercial |
$76.62
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$53.11 |
| Max. Negotiated Rate |
$124.35 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.46
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$124.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.11
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare VA CCN |
$53.11
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$124.35 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| 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 |
$54.70
|
| 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 |
$74.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.46
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$124.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.11
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare VA CCN |
$53.11
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9609328802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
INTERROG EVL PM/LDLS PM IP
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
9819328802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.11 |
| Max. Negotiated Rate |
$124.35 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.46
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$124.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.11
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.11
|
| Rate for Payer: United Healthcare VA CCN |
$53.11
|
|
|
INT HRHC LIG 2+HROID W/O IMG
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
9824694601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$361.74 |
| Max. Negotiated Rate |
$660.66 |
| Rate for Payer: Aetna of VT Commercial |
$642.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$372.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$506.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$475.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$475.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$416.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.98
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$660.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$595.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$595.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$361.74
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$361.74
|
| Rate for Payer: United Healthcare Commercial |
$556.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$361.74
|
| Rate for Payer: United Healthcare VA CCN |
$361.74
|
|
|
INT HRHC LIG 2+HROID W/O IMG
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
9824694601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Aetna of VT Commercial |
$648.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$611.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$553.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$542.99
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$307.35
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.35
|
| Rate for Payer: United Healthcare VA CCN |
$307.35
|
|
|
INT HRHC LIG 2+HROID W/O IMG
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
9824694601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$505.49 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Aetna of VT Commercial |
$648.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$580.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.40
|
| Rate for Payer: Cash Price |
$341.50
|
| Rate for Payer: Cigna Commercial |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$546.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$546.40
|
| Rate for Payer: Multiplan Commercial |
$635.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$580.55
|
| Rate for Payer: United Healthcare Commercial |
$648.85
|
|
