|
NJX AA&/STRD OTHER PN/BRANCH
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9606445002
|
|
Hospital Revenue Code
|
960
|
| 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 |
9606445002
|
|
Hospital Revenue Code
|
960
|
| 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 |
9606445002
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9606445001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$1,525.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,525.62
|
| 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 |
$40.09
|
| 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 |
$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 |
$811.50
|
| Rate for Payer: Cash Price |
$811.50
|
| 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 |
$1,509.39
|
| 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
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
9816445002
|
|
Hospital Revenue Code
|
981
|
| 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
|
$1,053.65
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
4506445001
|
|
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 PLTR COM DG NRV
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9826445501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna of VT Commercial |
$177.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.37
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$43.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$47.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare VA CCN |
$31.20
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9826445501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna of VT Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.05
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.05
|
| Rate for Payer: United Healthcare Commercial |
$179.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.05
|
| Rate for Payer: United Healthcare VA CCN |
$85.05
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna of VT Commercial |
$177.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.37
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$43.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$47.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare VA CCN |
$31.20
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$125.96 |
| Rate for Payer: Aetna of VT Commercial |
$125.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.37
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$43.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$124.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$47.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare VA CCN |
$31.20
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.40
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9826445501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna of VT Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.20
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.65
|
| Rate for Payer: United Healthcare Commercial |
$179.55
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna of VT Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.20
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.65
|
| Rate for Payer: United Healthcare Commercial |
$179.55
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna of VT Commercial |
$179.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.05
|
| Rate for Payer: Multiplan Commercial |
$175.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.05
|
| Rate for Payer: United Healthcare Commercial |
$179.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.05
|
| Rate for Payer: United Healthcare VA CCN |
$85.05
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.17 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Aetna of VT Commercial |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.20
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.20
|
| Rate for Payer: Multiplan Commercial |
$124.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.90
|
| Rate for Payer: United Healthcare Commercial |
$127.30
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
5106445501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Aetna of VT Commercial |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.53
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna Commercial |
$107.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.30
|
| Rate for Payer: Multiplan Commercial |
$124.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.30
|
| Rate for Payer: United Healthcare Commercial |
$127.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.30
|
| Rate for Payer: United Healthcare VA CCN |
$60.30
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.79
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.35
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare VA CCN |
$145.35
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
9606445501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$303.62 |
| Rate for Payer: Aetna of VT Commercial |
$303.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.37
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$43.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare Commercial |
$47.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.20
|
| Rate for Payer: United Healthcare VA CCN |
$31.20
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9816440002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna of VT Commercial |
$271.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.37
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.70
|
| Rate for Payer: Multiplan Commercial |
$265.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$271.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.70
|
| Rate for Payer: United Healthcare VA CCN |
$128.70
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
OP
|
$433.51
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
4506440001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$411.83 |
| Rate for Payer: Aetna of VT Commercial |
$411.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.64
|
| Rate for Payer: Cash Price |
$216.76
|
| Rate for Payer: Cigna Commercial |
$346.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.08
|
| Rate for Payer: Multiplan Commercial |
$403.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.08
|
| Rate for Payer: United Healthcare Commercial |
$411.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.08
|
| Rate for Payer: United Healthcare VA CCN |
$195.08
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9816440002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$268.84 |
| Rate for Payer: Aetna of VT Commercial |
$268.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.50
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.19
|
| Rate for Payer: Multiplan Commercial |
$265.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.37
|
| Rate for Payer: United Healthcare Commercial |
$72.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.37
|
| Rate for Payer: United Healthcare VA CCN |
$47.37
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9816440001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$204.27 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna of VT Commercial |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$256.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$234.60
|
| Rate for Payer: United Healthcare Commercial |
$262.20
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
IP
|
$433.51
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
4506440001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.84 |
| Max. Negotiated Rate |
$411.83 |
| Rate for Payer: Aetna of VT Commercial |
$411.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$346.81
|
| Rate for Payer: Cash Price |
$216.76
|
| Rate for Payer: Cigna Commercial |
$346.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$346.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$346.81
|
| Rate for Payer: Multiplan Commercial |
$403.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.48
|
| Rate for Payer: United Healthcare Commercial |
$411.83
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9826440001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna of VT Commercial |
$271.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.37
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.70
|
| Rate for Payer: Multiplan Commercial |
$265.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$128.70
|
| Rate for Payer: United Healthcare Commercial |
$271.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.70
|
| Rate for Payer: United Healthcare VA CCN |
$128.70
|
|
|
NJX AA&/STRD TRIGEMINAL NRV
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9826440001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$211.67 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna of VT Commercial |
$271.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.80
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$228.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$228.80
|
| Rate for Payer: Multiplan Commercial |
$265.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.10
|
| Rate for Payer: United Healthcare Commercial |
$271.70
|
|
