|
MUSCLE TEST THOR PARASPINAL
|
Facility
|
OP
|
$145.79
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
9229586901
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$64.57 |
| Max. Negotiated Rate |
$138.50 |
| Rate for Payer: Aetna of VT Commercial |
$138.50
|
| 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 |
$64.57
|
| 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 |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.90
|
| Rate for Payer: Cash Price |
$72.89
|
| Rate for Payer: Cigna Commercial |
$116.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.61
|
| Rate for Payer: Multiplan Commercial |
$135.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.61
|
| Rate for Payer: United Healthcare Commercial |
$138.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.61
|
| Rate for Payer: United Healthcare VA CCN |
$65.61
|
|
|
MUSCLE TEST THOR PARASPINAL
|
Facility
|
IP
|
$145.79
|
|
|
Service Code
|
CPT 95869
|
| Hospital Charge Code |
9229586901
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$138.50 |
| Rate for Payer: Aetna of VT Commercial |
$138.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.63
|
| Rate for Payer: Cash Price |
$72.89
|
| Rate for Payer: Cigna Commercial |
$116.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.63
|
| Rate for Payer: Multiplan Commercial |
$135.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.92
|
| Rate for Payer: United Healthcare Commercial |
$138.50
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$224.66 |
| Rate for Payer: Aetna of VT Commercial |
$224.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.53
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$137.64
|
| 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 |
$89.67
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare Commercial |
$137.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare VA CCN |
$89.67
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,107.19 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,256.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,196.80
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$662.58 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$662.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$900.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,211.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,189.32
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$673.20
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare VA CCN |
$673.20
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,406.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,406.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.53
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$137.64
|
| 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 |
$89.67
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare Commercial |
$137.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare VA CCN |
$89.67
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.20
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
IP
|
$136.49
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9229588602
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Aetna of VT Commercial |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.19
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.19
|
| Rate for Payer: Multiplan Commercial |
$126.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.02
|
| Rate for Payer: United Healthcare Commercial |
$129.67
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Professional
|
Both
|
$136.49
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9229588602
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of VT Commercial |
$128.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.53
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$137.64
|
| 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 |
$89.67
|
| Rate for Payer: Multiplan Commercial |
$126.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare Commercial |
$137.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.67
|
| Rate for Payer: United Healthcare VA CCN |
$89.67
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
OP
|
$136.49
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9229588602
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Aetna of VT Commercial |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$82.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.51
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.42
|
| Rate for Payer: Multiplan Commercial |
$126.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.42
|
| Rate for Payer: United Healthcare Commercial |
$129.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.42
|
| Rate for Payer: United Healthcare VA CCN |
$61.42
|
|
|
MUSC TEST DONE W/N TEST COMP
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
9609588602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.85 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Aetna of VT Commercial |
$227.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.00
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.55
|
| Rate for Payer: Multiplan Commercial |
$222.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.55
|
| Rate for Payer: United Healthcare Commercial |
$227.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.55
|
| Rate for Payer: United Healthcare VA CCN |
$107.55
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9229588502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9229588502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$523.99 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Aetna of VT Commercial |
$672.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$523.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$523.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$594.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$566.40
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$566.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$566.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$566.40
|
| Rate for Payer: Multiplan Commercial |
$658.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$601.80
|
| Rate for Payer: United Healthcare Commercial |
$672.60
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.40
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.83
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.85
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare VA CCN |
$50.85
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Professional
|
Both
|
$708.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.42 |
| Max. Negotiated Rate |
$665.52 |
| Rate for Payer: Aetna of VT Commercial |
$665.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.61
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$88.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.42
|
| Rate for Payer: Multiplan Commercial |
$658.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$88.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare VA CCN |
$57.42
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.42 |
| Max. Negotiated Rate |
$106.22 |
| Rate for Payer: Aetna of VT Commercial |
$106.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.61
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$88.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.42
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$88.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare VA CCN |
$57.42
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9609588501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$313.57 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Aetna of VT Commercial |
$672.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$426.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$601.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$573.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$318.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.86
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$566.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$566.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$566.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.60
|
| Rate for Payer: Multiplan Commercial |
$658.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$601.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.60
|
| Rate for Payer: United Healthcare Commercial |
$672.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.60
|
| Rate for Payer: United Healthcare VA CCN |
$318.60
|
|
|
MUSC TST DONE W/NERV TST LIM
|
Professional
|
Both
|
$110.64
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
9229588502
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$57.42 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna of VT Commercial |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.61
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.42
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare Commercial |
$88.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.42
|
| Rate for Payer: United Healthcare VA CCN |
$57.42
|
|
|
MYCOBACTERIA CULTURE
|
Facility
|
OP
|
$149.99
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
3008711601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna of VT Commercial |
$142.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.24
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$119.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$119.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$119.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$139.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$142.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare VA CCN |
$67.50
|
|
|
MYCOBACTERIA CULTURE
|
Facility
|
IP
|
$149.99
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
3008711601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna of VT Commercial |
$142.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.99
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$119.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$119.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$119.99
|
| Rate for Payer: Multiplan Commercial |
$139.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.49
|
| Rate for Payer: United Healthcare Commercial |
$142.49
|
|
|
MYCOBACTERIA CULTURE
|
Professional
|
Both
|
$149.99
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
3008711601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$140.99 |
| Rate for Payer: Aetna of VT Commercial |
$140.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.86
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$13.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$139.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$16.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare VA CCN |
$10.80
|
|
|
MYCOBACTERIC IDENTIFICATION
|
Facility
|
IP
|
$140.48
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
3008711801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.97 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Aetna of VT Commercial |
$133.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.38
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cigna Commercial |
$112.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.38
|
| Rate for Payer: Multiplan Commercial |
$130.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.41
|
| Rate for Payer: United Healthcare Commercial |
$133.46
|
|
|
MYCOBACTERIC IDENTIFICATION
|
Facility
|
OP
|
$140.48
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
3008711801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Aetna of VT Commercial |
$133.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.68
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cigna Commercial |
$112.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.22
|
| Rate for Payer: Multiplan Commercial |
$130.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$133.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare VA CCN |
$63.22
|
|
