|
MOD SED SAME PHYS/QHP EA
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
9819915302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$22.56 |
| Rate for Payer: Aetna of VT Commercial |
$22.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.70
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$13.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$17.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare VA CCN |
$11.26
|
|
|
MOD SED SAME PHYS/QHP EA
|
Facility
|
OP
|
$303.59
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
4509915301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$288.41 |
| Rate for Payer: Aetna of VT Commercial |
$288.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$241.35
|
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Cigna Commercial |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.62
|
| Rate for Payer: Multiplan Commercial |
$282.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.62
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.62
|
| Rate for Payer: United Healthcare VA CCN |
$136.62
|
|
|
MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
636J732701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$564.65 |
| Max. Negotiated Rate |
$1,825.01 |
| Rate for Payer: Aetna of VT Commercial |
$783.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,825.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$655.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,825.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$891.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$732.08
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$663.64
|
| Rate for Payer: Multiplan Commercial |
$775.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$636.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$636.59
|
| Rate for Payer: United Healthcare Commercial |
$979.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$636.59
|
| Rate for Payer: United Healthcare VA CCN |
$636.59
|
|
|
MONOVISC INJ PER DOSE
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
636J732701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.38 |
| Max. Negotiated Rate |
$1,825.01 |
| Rate for Payer: Aetna of VT Commercial |
$792.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,825.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$369.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,825.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$502.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$675.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$375.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$663.03
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$667.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$667.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$667.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$375.30
|
| Rate for Payer: Multiplan Commercial |
$775.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$375.30
|
| Rate for Payer: United Healthcare Commercial |
$792.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.30
|
| Rate for Payer: United Healthcare VA CCN |
$375.30
|
|
|
MONOVISC INJ PER DOSE
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
636J732701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Aetna of VT Commercial |
$792.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$617.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$617.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$667.20
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$667.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$667.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$667.20
|
| Rate for Payer: Multiplan Commercial |
$775.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.90
|
| Rate for Payer: United Healthcare Commercial |
$792.30
|
|
|
MORPHOMETRIC ANALYSIS TUMOR
|
Facility
|
IP
|
$449.88
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
3008835801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$332.96 |
| Max. Negotiated Rate |
$427.39 |
| Rate for Payer: Aetna of VT Commercial |
$427.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$382.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$359.90
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cigna Commercial |
$359.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.90
|
| Rate for Payer: Multiplan Commercial |
$418.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$382.40
|
| Rate for Payer: United Healthcare Commercial |
$427.39
|
|
|
MORPHOMETRIC ANALYSIS TUMOR
|
Facility
|
OP
|
$449.88
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
3008835801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$430.81 |
| Rate for Payer: Aetna of VT Commercial |
$427.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$382.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$357.65
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cigna Commercial |
$359.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.45
|
| Rate for Payer: Multiplan Commercial |
$418.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$382.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.45
|
| Rate for Payer: United Healthcare Commercial |
$427.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.52
|
| Rate for Payer: United Healthcare VA CCN |
$202.45
|
|
|
MORPHOMETRIC ANALYSIS TUMOR
|
Professional
|
Both
|
$449.88
|
|
|
Service Code
|
CPT 88358
|
| Hospital Charge Code |
3008835801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$430.81 |
| Rate for Payer: Aetna of VT Commercial |
$422.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$133.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$181.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.68
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cash Price |
$224.94
|
| Rate for Payer: Cigna Commercial |
$175.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.52
|
| Rate for Payer: Multiplan Commercial |
$418.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.52
|
| Rate for Payer: United Healthcare Commercial |
$199.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.52
|
| Rate for Payer: United Healthcare VA CCN |
$129.52
|
|
|
MOTION FLUOROSCOPY/SWALLOW
|
Facility
|
IP
|
$613.16
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4409261101
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$453.80 |
| Max. Negotiated Rate |
$582.50 |
| Rate for Payer: Aetna of VT Commercial |
$582.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$453.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$453.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$515.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.53
|
| Rate for Payer: Cash Price |
$306.58
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.53
|
| Rate for Payer: Multiplan Commercial |
$570.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.19
|
| Rate for Payer: United Healthcare Commercial |
$582.50
|
|
|
MOTION FLUOROSCOPY/SWALLOW
|
Facility
|
OP
|
$613.16
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4409261101
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$271.57 |
| Max. Negotiated Rate |
$582.50 |
| Rate for Payer: Aetna of VT Commercial |
$582.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$271.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$369.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.46
|
| Rate for Payer: Cash Price |
$306.58
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$275.92
|
| Rate for Payer: Multiplan Commercial |
$570.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$343.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$275.92
|
| Rate for Payer: United Healthcare Commercial |
$582.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.92
|
| Rate for Payer: United Healthcare VA CCN |
$275.92
|
|
|
MOTO E-CROSS TIB INST S4 H8 RM
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780073961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.71 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,543.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,455.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$719.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,455.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$978.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,381.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,316.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$731.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,291.88
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cigna Commercial |
$1,300.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,300.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,300.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$731.25
|
| Rate for Payer: Multiplan Commercial |
$1,511.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,381.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$731.25
|
| Rate for Payer: United Healthcare Commercial |
$1,543.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$731.25
|
| Rate for Payer: United Healthcare VA CCN |
$731.25
|
|
|
MOTO E-CROSS TIB INST S4 H8 RM
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780073961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,202.66 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,543.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,202.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,202.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,381.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,365.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,300.00
|
| Rate for Payer: Cash Price |
$812.50
|
| Rate for Payer: Cigna Commercial |
$1,300.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,300.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,300.00
|
| Rate for Payer: Multiplan Commercial |
$1,511.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,543.75
|
|
|
MOTO E-CROSS TIB INST S5 H8 LM
|
Facility
|
IP
|
$1,290.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.20 |
| Max. Negotiated Rate |
$1,226.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$955.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$955.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,097.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,084.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,032.50
|
| Rate for Payer: Cash Price |
$645.32
|
| Rate for Payer: Cigna Commercial |
$1,032.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,032.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,032.50
|
| Rate for Payer: Multiplan Commercial |
$1,200.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,097.04
|
| Rate for Payer: United Healthcare Commercial |
$1,226.10
|
|
|
MOTO E-CROSS TIB INST S5 H8 LM
|
Facility
|
OP
|
$1,290.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.62 |
| Max. Negotiated Rate |
$1,226.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,156.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$571.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,156.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$776.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,097.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,045.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$580.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,026.05
|
| Rate for Payer: Cash Price |
$645.32
|
| Rate for Payer: Cigna Commercial |
$1,032.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,032.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,032.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$580.78
|
| Rate for Payer: Multiplan Commercial |
$1,200.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,097.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$580.78
|
| Rate for Payer: United Healthcare Commercial |
$1,226.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$580.78
|
| Rate for Payer: United Healthcare VA CCN |
$580.78
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare VA CCN |
$33.30
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.20
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$86.24 |
| Rate for Payer: Aetna of VT Commercial |
$69.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.24
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$47.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare VA CCN |
$31.18
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
OP
|
$332.95
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9229590502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$147.46 |
| Max. Negotiated Rate |
$316.30 |
| Rate for Payer: Aetna of VT Commercial |
$316.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$200.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$269.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$149.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.70
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cigna Commercial |
$266.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$149.83
|
| Rate for Payer: Multiplan Commercial |
$309.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.83
|
| Rate for Payer: United Healthcare Commercial |
$316.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Healthcare VA CCN |
$149.83
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
IP
|
$332.95
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9229590502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$246.42 |
| Max. Negotiated Rate |
$316.30 |
| Rate for Payer: Aetna of VT Commercial |
$316.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$246.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$246.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$279.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$266.36
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cigna Commercial |
$266.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.36
|
| Rate for Payer: Multiplan Commercial |
$309.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.01
|
| Rate for Payer: United Healthcare Commercial |
$316.30
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare VA CCN |
$33.30
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Professional
|
Both
|
$332.95
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9229590502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$312.97 |
| Rate for Payer: Aetna of VT Commercial |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.24
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cash Price |
$166.48
|
| Rate for Payer: Cigna Commercial |
$47.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$309.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare VA CCN |
$31.18
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.20
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
|
|
MOTOR &/ SENS NRVE CNDJ TEST
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
9609590502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$86.24 |
| Rate for Payer: Aetna of VT Commercial |
$69.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.24
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$47.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare VA CCN |
$31.18
|
|
|
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
Facility
|
IP
|
$1,016.34
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
3008837701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$752.19 |
| Max. Negotiated Rate |
$965.52 |
| Rate for Payer: Aetna of VT Commercial |
$965.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$863.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$853.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$813.07
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cigna Commercial |
$813.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$813.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$813.07
|
| Rate for Payer: Multiplan Commercial |
$945.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$863.89
|
| Rate for Payer: United Healthcare Commercial |
$965.52
|
|
|
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
Professional
|
Both
|
$1,016.34
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
3008837701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$1,615.09 |
| Rate for Payer: Aetna of VT Commercial |
$955.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,615.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,615.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$522.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$516.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$516.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.79
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cigna Commercial |
$509.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$598.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$598.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$373.26
|
| Rate for Payer: Multiplan Commercial |
$945.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.26
|
| Rate for Payer: United Healthcare Commercial |
$574.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.26
|
| Rate for Payer: United Healthcare VA CCN |
$373.26
|
|
