|
MR SI JOINT WO/W CONTRAST
|
Facility
|
OP
|
$4,237.33
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
6107219702
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,055.61 |
| Max. Negotiated Rate |
$4,025.46 |
| Rate for Payer: Aetna of VT Commercial |
$4,025.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,055.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,876.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,055.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,550.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,601.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,432.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,906.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,368.68
|
| Rate for Payer: Cash Price |
$2,118.66
|
| Rate for Payer: Cash Price |
$2,118.66
|
| Rate for Payer: Cigna Commercial |
$3,389.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,389.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,389.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,906.80
|
| Rate for Payer: Multiplan Commercial |
$3,940.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,601.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,906.80
|
| Rate for Payer: United Healthcare Commercial |
$4,025.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,906.80
|
| Rate for Payer: United Healthcare VA CCN |
$1,906.80
|
|
|
MR SI JOINT WO/W CONTRAST
|
Facility
|
IP
|
$4,237.33
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
6107219702
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,136.05 |
| Max. Negotiated Rate |
$4,025.46 |
| Rate for Payer: Aetna of VT Commercial |
$4,025.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,136.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,136.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,601.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,559.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,389.86
|
| Rate for Payer: Cash Price |
$2,118.66
|
| Rate for Payer: Cigna Commercial |
$3,389.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,389.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,389.86
|
| Rate for Payer: Multiplan Commercial |
$3,940.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,601.73
|
| Rate for Payer: United Healthcare Commercial |
$4,025.46
|
|
|
M.TUBERCULO DNA AMP PROBE
|
Facility
|
OP
|
$327.78
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
3008755601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$311.39 |
| Rate for Payer: Aetna of VT Commercial |
$311.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.59
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cigna Commercial |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$304.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.50
|
| Rate for Payer: United Healthcare Commercial |
$311.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.68
|
| Rate for Payer: United Healthcare VA CCN |
$147.50
|
|
|
M.TUBERCULO DNA AMP PROBE
|
Facility
|
IP
|
$327.78
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
3008755601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$242.59 |
| Max. Negotiated Rate |
$311.39 |
| Rate for Payer: Aetna of VT Commercial |
$311.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.22
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cigna Commercial |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.22
|
| Rate for Payer: Multiplan Commercial |
$304.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.61
|
| Rate for Payer: United Healthcare Commercial |
$311.39
|
|
|
M.TUBERCULO DNA AMP PROBE
|
Professional
|
Both
|
$327.78
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
3008755601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.10 |
| Max. Negotiated Rate |
$308.11 |
| Rate for Payer: Aetna of VT Commercial |
$308.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.68
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cigna Commercial |
$50.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.10
|
| Rate for Payer: Multiplan Commercial |
$304.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.68
|
| Rate for Payer: United Healthcare Commercial |
$64.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.68
|
| Rate for Payer: United Healthcare VA CCN |
$41.68
|
|
|
MUPIROCIN 2% OINT
|
Professional
|
Both
|
$5.69
|
|
| Hospital Charge Code |
2500000204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna of VT Commercial |
$5.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.10
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare VA CCN |
$2.28
|
|
|
MUPIROCIN 2% OINT
|
Professional
|
Both
|
$5.69
|
|
|
Service Code
|
NDC 6846218022
|
| Hospital Charge Code |
2500000204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna of VT Commercial |
$5.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.10
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$5.29
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare VA CCN |
$2.28
|
|
|
MUSCLE-SPECIFIC KINASE ANTB
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
3008636601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.98 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna of VT Commercial |
$409.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$366.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$362.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.80
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$344.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.80
|
| Rate for Payer: Multiplan Commercial |
$400.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.35
|
| Rate for Payer: United Healthcare Commercial |
$409.45
|
|
|
MUSCLE-SPECIFIC KINASE ANTB
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
3008636601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna of VT Commercial |
$409.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$366.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$349.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$342.64
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$344.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.95
|
| Rate for Payer: Multiplan Commercial |
$400.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.95
|
| Rate for Payer: United Healthcare Commercial |
$409.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare VA CCN |
$193.95
|
|
|
MUSCLE TEST 2 LIMBS
|
Facility
|
IP
|
$340.19
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
9229586101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$251.77 |
| Max. Negotiated Rate |
$323.18 |
| Rate for Payer: Aetna of VT Commercial |
$323.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$251.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$251.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.15
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$272.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.15
|
| Rate for Payer: Multiplan Commercial |
$316.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.16
|
| Rate for Payer: United Healthcare Commercial |
$323.18
|
|
|
MUSCLE TEST 2 LIMBS
|
Professional
|
Both
|
$340.19
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
9229586101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$147.67 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna of VT Commercial |
$319.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$218.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.45
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$227.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.67
|
| Rate for Payer: Multiplan Commercial |
$316.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.67
|
| Rate for Payer: United Healthcare Commercial |
$227.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.67
|
| Rate for Payer: United Healthcare VA CCN |
$147.67
|
|
|
MUSCLE TEST 2 LIMBS
|
Facility
|
OP
|
$340.19
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
9229586101
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$323.18 |
| Rate for Payer: Aetna of VT Commercial |
$323.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$150.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$204.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.45
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$272.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$316.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.09
|
| Rate for Payer: United Healthcare Commercial |
$323.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.09
|
| Rate for Payer: United Healthcare VA CCN |
$153.09
|
|
|
MUSCLE TEST 3 LIMBS
|
Facility
|
IP
|
$437.79
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
9229586301
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$324.01 |
| Max. Negotiated Rate |
$415.90 |
| Rate for Payer: Aetna of VT Commercial |
$415.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.23
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna Commercial |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Multiplan Commercial |
$407.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.12
|
| Rate for Payer: United Healthcare Commercial |
$415.90
|
|
|
MUSCLE TEST 3 LIMBS
|
Professional
|
Both
|
$437.79
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
9229586301
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$200.91 |
| Max. Negotiated Rate |
$411.52 |
| Rate for Payer: Aetna of VT Commercial |
$411.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$231.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.48
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna Commercial |
$296.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$200.91
|
| Rate for Payer: Multiplan Commercial |
$407.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$285.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$200.91
|
| Rate for Payer: United Healthcare Commercial |
$309.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.91
|
| Rate for Payer: United Healthcare VA CCN |
$200.91
|
|
|
MUSCLE TEST 3 LIMBS
|
Facility
|
OP
|
$437.79
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
9229586301
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$415.90 |
| Rate for Payer: Aetna of VT Commercial |
$415.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.04
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna Commercial |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.01
|
| Rate for Payer: Multiplan Commercial |
$407.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.01
|
| Rate for Payer: United Healthcare Commercial |
$415.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.01
|
| Rate for Payer: United Healthcare VA CCN |
$197.01
|
|
|
MUSCLE TEST 4 LIMBS
|
Professional
|
Both
|
$780.67
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
9229586401
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$212.34 |
| Max. Negotiated Rate |
$733.83 |
| Rate for Payer: Aetna of VT Commercial |
$733.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$699.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$699.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$297.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$317.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.93
|
| Rate for Payer: Cash Price |
$390.34
|
| Rate for Payer: Cash Price |
$390.34
|
| Rate for Payer: Cigna Commercial |
$330.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$341.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$341.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.34
|
| Rate for Payer: Multiplan Commercial |
$726.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.35
|
| Rate for Payer: United Healthcare Commercial |
$326.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.35
|
| Rate for Payer: United Healthcare VA CCN |
$212.35
|
|
|
MUSCLE TEST 4 LIMBS
|
Facility
|
IP
|
$780.67
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
9229586401
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$577.77 |
| Max. Negotiated Rate |
$741.64 |
| Rate for Payer: Aetna of VT Commercial |
$741.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.54
|
| Rate for Payer: Cash Price |
$390.34
|
| Rate for Payer: Cigna Commercial |
$624.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.54
|
| Rate for Payer: Multiplan Commercial |
$726.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.57
|
| Rate for Payer: United Healthcare Commercial |
$741.64
|
|
|
MUSCLE TEST 4 LIMBS
|
Facility
|
OP
|
$780.67
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
9229586401
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$345.76 |
| Max. Negotiated Rate |
$741.64 |
| Rate for Payer: Aetna of VT Commercial |
$741.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$699.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$699.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$469.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$632.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$351.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$620.63
|
| Rate for Payer: Cash Price |
$390.34
|
| Rate for Payer: Cigna Commercial |
$624.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$351.30
|
| Rate for Payer: Multiplan Commercial |
$726.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$351.30
|
| Rate for Payer: United Healthcare Commercial |
$741.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$351.30
|
| Rate for Payer: United Healthcare VA CCN |
$351.30
|
|
|
MUSCLE TEST NONPARASPINAL
|
Professional
|
Both
|
$135.45
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
9229587001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$127.32 |
| Rate for Payer: Aetna of VT Commercial |
$127.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.79
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cigna Commercial |
$118.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$125.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.71
|
| Rate for Payer: United Healthcare Commercial |
$118.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.71
|
| Rate for Payer: United Healthcare VA CCN |
$76.71
|
|
|
MUSCLE TEST NONPARASPINAL
|
Facility
|
IP
|
$135.45
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
9229587001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$128.68 |
| Rate for Payer: Aetna of VT Commercial |
$128.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.36
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cigna Commercial |
$108.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.36
|
| Rate for Payer: Multiplan Commercial |
$125.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.13
|
| Rate for Payer: United Healthcare Commercial |
$128.68
|
|
|
MUSCLE TEST NONPARASPINAL
|
Facility
|
OP
|
$135.45
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
9229587001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$128.68 |
| Rate for Payer: Aetna of VT Commercial |
$128.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.68
|
| Rate for Payer: Cash Price |
$67.72
|
| Rate for Payer: Cigna Commercial |
$108.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.95
|
| Rate for Payer: Multiplan Commercial |
$125.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.95
|
| Rate for Payer: United Healthcare Commercial |
$128.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.95
|
| Rate for Payer: United Healthcare VA CCN |
$60.95
|
|
|
MUSCLE TEST ONE LIMB
|
Professional
|
Both
|
$109.60
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
9229586001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$170.24 |
| Rate for Payer: Aetna of VT Commercial |
$103.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.43
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$160.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.77
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.77
|
| Rate for Payer: United Healthcare Commercial |
$162.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.77
|
| Rate for Payer: United Healthcare VA CCN |
$105.77
|
|
|
MUSCLE TEST ONE LIMB
|
Facility
|
OP
|
$109.60
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
9229586001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$48.54 |
| Max. Negotiated Rate |
$104.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.13
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.32
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.32
|
| Rate for Payer: United Healthcare VA CCN |
$49.32
|
|
|
MUSCLE TEST ONE LIMB
|
Facility
|
IP
|
$109.60
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
9229586001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$104.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.68
|
| Rate for Payer: Cash Price |
$54.80
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.68
|
| Rate for Payer: Multiplan Commercial |
$101.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.16
|
| Rate for Payer: United Healthcare Commercial |
$104.12
|
|
|
MUSCLE TEST THOR PARASPINAL
|
Professional
|
Both
|
$145.79
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
9229586901
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$86.99 |
| Max. Negotiated Rate |
$139.89 |
| Rate for Payer: Aetna of VT Commercial |
$137.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.08
|
| Rate for Payer: Cash Price |
$72.89
|
| Rate for Payer: Cash Price |
$72.89
|
| Rate for Payer: Cigna Commercial |
$136.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$139.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$139.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.99
|
| Rate for Payer: Multiplan Commercial |
$135.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.99
|
| Rate for Payer: United Healthcare Commercial |
$133.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.99
|
| Rate for Payer: United Healthcare VA CCN |
$86.99
|
|
