|
NASAL/OROGASTRIC W/TUBE PLMT
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 43752
|
| Hospital Charge Code |
9814375201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$179.55
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare VA CCN |
$179.55
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$221.28
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
4509251101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$210.22 |
| Rate for Payer: Aetna of VT Commercial |
$210.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.92
|
| Rate for Payer: Cash Price |
$110.64
|
| Rate for Payer: Cigna Commercial |
$177.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.58
|
| Rate for Payer: Multiplan Commercial |
$205.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.58
|
| Rate for Payer: United Healthcare Commercial |
$210.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.58
|
| Rate for Payer: United Healthcare VA CCN |
$99.58
|
|
|
NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$195.63 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.63
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$41.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare Commercial |
$55.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare VA CCN |
$36.14
|
|
|
NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$375.06 |
| Rate for Payer: Aetna of VT Commercial |
$375.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.63
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$41.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare Commercial |
$55.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare VA CCN |
$36.14
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
5109251101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.60
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
|
|
NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
5109251101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$208.68 |
| Rate for Payer: Aetna of VT Commercial |
$208.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.63
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$41.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare Commercial |
$55.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare VA CCN |
$36.14
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna of VT Commercial |
$589.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$521.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.80
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$275.04 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna of VT Commercial |
$589.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$373.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$493.69
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$279.45
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare VA CCN |
$279.45
|
|
|
NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$583.74 |
| Rate for Payer: Aetna of VT Commercial |
$583.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.63
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$41.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare Commercial |
$55.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare VA CCN |
$36.14
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$323.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$317.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$179.55
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.55
|
| Rate for Payer: United Healthcare VA CCN |
$179.55
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
5109251101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.49
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare VA CCN |
$99.90
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$295.30 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$295.30 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna of VT Commercial |
$379.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$295.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.20
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$319.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$379.05
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
IP
|
$221.28
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
4509251101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.77 |
| Max. Negotiated Rate |
$210.22 |
| Rate for Payer: Aetna of VT Commercial |
$210.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.02
|
| Rate for Payer: Cash Price |
$110.64
|
| Rate for Payer: Cigna Commercial |
$177.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.02
|
| Rate for Payer: Multiplan Commercial |
$205.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.09
|
| Rate for Payer: United Healthcare Commercial |
$210.22
|
|
|
NASOPHARYNGOSCOPY
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9819251101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
NASOPHARYNGOSCOPY
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
9609251102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$375.06 |
| Rate for Payer: Aetna of VT Commercial |
$375.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.63
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$41.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.66
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare Commercial |
$55.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.14
|
| Rate for Payer: United Healthcare VA CCN |
$36.14
|
|
|
NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$322.26
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
3008388001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$306.15 |
| Rate for Payer: Aetna of VT Commercial |
$306.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.81
|
| Rate for Payer: Cash Price |
$161.13
|
| Rate for Payer: Cigna Commercial |
$257.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.81
|
| Rate for Payer: Multiplan Commercial |
$299.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.92
|
| Rate for Payer: United Healthcare Commercial |
$306.15
|
|
|
NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$322.26
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
3008388001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$306.15 |
| Rate for Payer: Aetna of VT Commercial |
$306.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.20
|
| Rate for Payer: Cash Price |
$161.13
|
| Rate for Payer: Cash Price |
$161.13
|
| Rate for Payer: Cigna Commercial |
$257.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.02
|
| Rate for Payer: Multiplan Commercial |
$299.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.02
|
| Rate for Payer: United Healthcare Commercial |
$306.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.26
|
| Rate for Payer: United Healthcare VA CCN |
$145.02
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
OP
|
$600.07
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
4506450501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.77 |
| Max. Negotiated Rate |
$570.07 |
| Rate for Payer: Aetna of VT Commercial |
$570.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$537.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$537.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$486.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$477.06
|
| Rate for Payer: Cash Price |
$300.04
|
| Rate for Payer: Cigna Commercial |
$480.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$480.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$480.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$270.03
|
| Rate for Payer: Multiplan Commercial |
$558.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$510.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.03
|
| Rate for Payer: United Healthcare Commercial |
$570.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.03
|
| Rate for Payer: United Healthcare VA CCN |
$270.03
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.42 |
| Max. Negotiated Rate |
$500.08 |
| Rate for Payer: Aetna of VT Commercial |
$500.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.62
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$135.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.32
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare Commercial |
$149.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare VA CCN |
$97.42
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9816450501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$225.78 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.62
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$135.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$225.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$225.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.32
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare Commercial |
$149.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.42
|
| Rate for Payer: United Healthcare VA CCN |
$97.42
|
|
|
N BLOCK SPENOPALATINE GANGL
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
9826450501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$393.73 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of VT Commercial |
$505.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$393.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$452.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$425.60
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$425.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$425.60
|
| Rate for Payer: Multiplan Commercial |
$494.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$452.20
|
| Rate for Payer: United Healthcare Commercial |
$505.40
|
|
