|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
IP
|
$2,323.40
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
4506442101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,719.55 |
| Max. Negotiated Rate |
$2,207.23 |
| Rate for Payer: Aetna of VT Commercial |
$2,207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,719.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,719.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,974.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,951.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,858.72
|
| Rate for Payer: Cash Price |
$1,161.70
|
| Rate for Payer: Cigna Commercial |
$1,858.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,858.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,858.72
|
| Rate for Payer: Multiplan Commercial |
$2,160.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,974.89
|
| Rate for Payer: United Healthcare Commercial |
$2,207.23
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442101
|
|
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 NTRCOST NRV EA
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9826442101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$546.14 |
| Rate for Payer: Aetna of VT Commercial |
$546.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.76
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$32.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.62
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$35.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare VA CCN |
$22.95
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442101
|
|
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 NTRCOST NRV EA
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9826442101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Aetna of VT Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$488.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.80
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.80
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.85
|
| Rate for Payer: United Healthcare Commercial |
$551.95
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
OP
|
$2,323.40
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
4506442101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,029.03 |
| Max. Negotiated Rate |
$2,207.23 |
| Rate for Payer: Aetna of VT Commercial |
$2,207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,081.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,029.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,081.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,398.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,974.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,881.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,045.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,847.10
|
| Rate for Payer: Cash Price |
$1,161.70
|
| Rate for Payer: Cigna Commercial |
$1,858.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,858.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,858.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,045.53
|
| Rate for Payer: Multiplan Commercial |
$2,160.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,974.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,045.53
|
| Rate for Payer: United Healthcare Commercial |
$2,207.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,045.53
|
| Rate for Payer: United Healthcare VA CCN |
$1,045.53
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9826442101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Aetna of VT Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$257.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$349.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$461.89
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$261.45
|
| Rate for Payer: United Healthcare Commercial |
$551.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$261.45
|
| Rate for Payer: United Healthcare VA CCN |
$261.45
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$81.76 |
| 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 |
$23.64
|
| 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 |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.76
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$32.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.62
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$35.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare VA CCN |
$22.95
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$546.14 |
| Rate for Payer: Aetna of VT Commercial |
$546.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.76
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$32.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.62
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$35.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare VA CCN |
$22.95
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Aetna of VT Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$257.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$520.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$349.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$470.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$461.89
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$261.45
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$261.45
|
| Rate for Payer: United Healthcare Commercial |
$551.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$261.45
|
| Rate for Payer: United Healthcare VA CCN |
$261.45
|
|
|
NJX AA&/STRD NTRCOST NRV EA
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
9816442102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$551.95 |
| Rate for Payer: Aetna of VT Commercial |
$551.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$430.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$430.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$488.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.80
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.80
|
| Rate for Payer: Multiplan Commercial |
$540.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.85
|
| Rate for Payer: United Healthcare Commercial |
$551.95
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Professional
|
Both
|
$1,054.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$990.76 |
| Rate for Payer: Aetna of VT Commercial |
$990.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$944.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$944.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.73
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna Commercial |
$54.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$980.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare Commercial |
$59.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare VA CCN |
$38.92
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445001
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9826445001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$421.12 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$477.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$455.20
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9826445001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$252.01 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$342.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.36
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.05
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare VA CCN |
$256.05
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$466.82 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,001.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$944.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$944.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$634.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$853.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$474.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$837.93
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$843.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$843.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$474.30
|
| Rate for Payer: Multiplan Commercial |
$980.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.30
|
| Rate for Payer: United Healthcare Commercial |
$1,001.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.30
|
| Rate for Payer: United Healthcare VA CCN |
$474.30
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
5106445001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$780.07 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,001.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$780.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$780.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$895.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$885.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$843.20
|
| Rate for Payer: Cash Price |
$527.00
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$843.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$843.20
|
| Rate for Payer: Multiplan Commercial |
$980.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$895.90
|
| Rate for Payer: United Healthcare Commercial |
$1,001.30
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$252.01 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$342.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$460.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$452.36
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.05
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.05
|
| Rate for Payer: United Healthcare VA CCN |
$256.05
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445001
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
OP
|
$1,053.65
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
4506445001
|
|
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 OTHER PN/BRANCH
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9606445001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$718.83 |
| Max. Negotiated Rate |
$1,541.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,541.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,454.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$718.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,454.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$977.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,379.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,314.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$730.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,290.29
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$1,298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,298.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$730.35
|
| Rate for Payer: Multiplan Commercial |
$1,509.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,379.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$730.35
|
| Rate for Payer: United Healthcare Commercial |
$1,541.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$730.35
|
| Rate for Payer: United Healthcare VA CCN |
$730.35
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9826445001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$534.86 |
| Rate for Payer: Aetna of VT Commercial |
$534.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$509.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.73
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$54.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare Commercial |
$59.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare VA CCN |
$38.92
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$421.12 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna of VT Commercial |
$540.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$477.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$455.20
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$455.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$455.20
|
| Rate for Payer: Multiplan Commercial |
$529.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.65
|
| Rate for Payer: United Healthcare Commercial |
$540.55
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.92 |
| 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 |
$40.09
|
| 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 |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.73
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$54.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare Commercial |
$59.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.92
|
| Rate for Payer: United Healthcare VA CCN |
$38.92
|
|
|
NJX AA&/STRD OTHER PN/BRANCH
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9606445001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,201.18 |
| Max. Negotiated Rate |
$1,541.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,541.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,379.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,363.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,298.40
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$1,298.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,298.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,298.40
|
| Rate for Payer: Multiplan Commercial |
$1,509.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,379.55
|
| Rate for Payer: United Healthcare Commercial |
$1,541.85
|
|
