|
NJ GADOTERATE MEGLUMI 15 ml
|
Facility
|
IP
|
$105.25
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
636A957501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Aetna of VT Commercial |
$99.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.20
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$97.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.46
|
| Rate for Payer: United Healthcare Commercial |
$99.99
|
|
|
NJX AA&/STRD BRCH PLXS IMG
|
Facility
|
IP
|
$979.20
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3706441501
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$724.71 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna of VT Commercial |
$930.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$724.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$724.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$832.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$822.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$783.36
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$783.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$783.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$783.36
|
| Rate for Payer: Multiplan Commercial |
$910.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$832.32
|
| Rate for Payer: United Healthcare Commercial |
$930.24
|
|
|
NJX AA&/STRD BRCH PLXS IMG
|
Facility
|
OP
|
$979.20
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
3706441501
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$433.69 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna of VT Commercial |
$930.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$877.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$433.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$877.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$589.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$832.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$793.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$440.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$778.46
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$783.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$783.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$783.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$440.64
|
| Rate for Payer: Multiplan Commercial |
$910.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$832.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$930.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$440.64
|
| Rate for Payer: United Healthcare VA CCN |
$440.64
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$589.86 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Aetna of VT Commercial |
$757.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$677.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$637.60
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$637.60
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$677.45
|
| Rate for Payer: United Healthcare Commercial |
$757.15
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$749.18 |
| Rate for Payer: Aetna of VT Commercial |
$749.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.12
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$82.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.09
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare Commercial |
$91.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare VA CCN |
$59.33
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444701
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$178.97 |
| 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 |
$61.11
|
| 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 |
$83.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.12
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$82.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.09
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare Commercial |
$91.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare VA CCN |
$59.33
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
OP
|
$1,053.65
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
4506444701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$466.66 |
| Max. Negotiated Rate |
$1,000.97 |
| Rate for Payer: Aetna of VT Commercial |
$1,000.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$943.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$943.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$853.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$474.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$837.65
|
| Rate for Payer: Cash Price |
$526.82
|
| Rate for Payer: Cigna Commercial |
$842.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$474.14
|
| Rate for Payer: Multiplan Commercial |
$979.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.14
|
| Rate for Payer: United Healthcare Commercial |
$1,000.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.14
|
| Rate for Payer: United Healthcare VA CCN |
$474.14
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
IP
|
$1,053.65
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
4506444701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$779.81 |
| Max. Negotiated Rate |
$1,000.97 |
| Rate for Payer: Aetna of VT Commercial |
$1,000.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$779.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$779.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$885.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$842.92
|
| Rate for Payer: Cash Price |
$526.82
|
| Rate for Payer: Cigna Commercial |
$842.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$842.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$842.92
|
| Rate for Payer: Multiplan Commercial |
$979.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.60
|
| Rate for Payer: United Healthcare Commercial |
$1,000.97
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444701
|
|
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
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444701
|
|
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
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9826444701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$749.18 |
| Rate for Payer: Aetna of VT Commercial |
$749.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.12
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$82.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.09
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare Commercial |
$91.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.33
|
| Rate for Payer: United Healthcare VA CCN |
$59.33
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9826444701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$352.99 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Aetna of VT Commercial |
$757.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$352.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$479.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$677.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$645.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$358.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$633.62
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$637.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$358.65
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$677.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$358.65
|
| Rate for Payer: United Healthcare Commercial |
$757.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$358.65
|
| Rate for Payer: United Healthcare VA CCN |
$358.65
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9826444701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$589.86 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Aetna of VT Commercial |
$757.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$677.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$669.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$637.60
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$637.60
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$677.45
|
| Rate for Payer: United Healthcare Commercial |
$757.15
|
|
|
NJX AA&/STRD FEMORAL NRV IMG
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
9816444702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$352.99 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Aetna of VT Commercial |
$757.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$352.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$479.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$677.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$645.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$358.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$633.62
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$637.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$637.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$358.65
|
| Rate for Payer: Multiplan Commercial |
$741.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$677.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$358.65
|
| Rate for Payer: United Healthcare Commercial |
$757.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$358.65
|
| Rate for Payer: United Healthcare VA CCN |
$358.65
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9826440501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$304.27 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna of VT Commercial |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$304.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$413.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$556.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$309.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.16
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$549.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$309.15
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$309.15
|
| Rate for Payer: United Healthcare Commercial |
$652.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.15
|
| Rate for Payer: United Healthcare VA CCN |
$309.15
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$508.45 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna of VT Commercial |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$508.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$508.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$577.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$549.60
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.95
|
| Rate for Payer: United Healthcare Commercial |
$652.65
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$645.78 |
| Rate for Payer: Aetna of VT Commercial |
$645.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.13
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$66.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare Commercial |
$73.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare VA CCN |
$47.90
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.40
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9826440501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$508.45 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna of VT Commercial |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$508.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$508.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$577.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$549.60
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.95
|
| Rate for Payer: United Healthcare Commercial |
$652.65
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
OP
|
$117.36
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
4506440501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$111.49 |
| Rate for Payer: Aetna of VT Commercial |
$111.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.30
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cigna Commercial |
$93.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.81
|
| Rate for Payer: Multiplan Commercial |
$109.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.81
|
| Rate for Payer: United Healthcare Commercial |
$111.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.81
|
| Rate for Payer: United Healthcare VA CCN |
$52.81
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$247.22 |
| Rate for Payer: Aetna of VT Commercial |
$247.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.13
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$66.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare Commercial |
$73.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare VA CCN |
$47.90
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
IP
|
$117.36
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
4506440501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$111.49 |
| Rate for Payer: Aetna of VT Commercial |
$111.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.89
|
| Rate for Payer: Cash Price |
$58.68
|
| Rate for Payer: Cigna Commercial |
$93.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.89
|
| Rate for Payer: Multiplan Commercial |
$109.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.76
|
| Rate for Payer: United Healthcare Commercial |
$111.49
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9826440501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$645.78 |
| Rate for Payer: Aetna of VT Commercial |
$645.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.13
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$66.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare Commercial |
$73.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.90
|
| Rate for Payer: United Healthcare VA CCN |
$47.90
|
|
|
NJX AA&/STRD GR OCPL NRV
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
9816440502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$304.27 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna of VT Commercial |
$652.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$304.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$615.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$413.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$556.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$309.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.16
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$549.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$549.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$309.15
|
| Rate for Payer: Multiplan Commercial |
$638.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$309.15
|
| Rate for Payer: United Healthcare Commercial |
$652.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.15
|
| Rate for Payer: United Healthcare VA CCN |
$309.15
|
|
