|
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
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9816440001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$122.24 |
| 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 |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.42
|
| 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: Martins Point Health Care Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$256.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$234.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.20
|
| Rate for Payer: United Healthcare Commercial |
$262.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.20
|
| Rate for Payer: United Healthcare VA CCN |
$124.20
|
|
|
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
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
9816440001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$259.44 |
| Rate for Payer: Aetna of VT Commercial |
$259.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.27
|
| 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 |
$247.27
|
| 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 |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| 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 |
$256.68
|
| 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 INTERLAMINAR CRV/THRC
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$536.74 |
| Rate for Payer: Aetna of VT Commercial |
$536.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.31
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$116.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.34
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare Commercial |
$128.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare VA CCN |
$83.73
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9826232401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$252.90 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna of VT Commercial |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$343.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$485.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$453.94
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.95
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.95
|
| Rate for Payer: United Healthcare Commercial |
$542.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.95
|
| Rate for Payer: United Healthcare VA CCN |
$256.95
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232401
|
|
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 INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232401
|
|
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 INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$252.90 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna of VT Commercial |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$343.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$485.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$453.94
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.95
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.95
|
| Rate for Payer: United Healthcare Commercial |
$542.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.95
|
| Rate for Payer: United Healthcare VA CCN |
$256.95
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$210.35 |
| 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 |
$86.24
|
| 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 |
$117.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.31
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$116.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.34
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare Commercial |
$128.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare VA CCN |
$83.73
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9826232401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$422.60 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna of VT Commercial |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$422.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$422.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$485.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$479.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.80
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.80
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.35
|
| Rate for Payer: United Healthcare Commercial |
$542.45
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9816232402
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$422.60 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna of VT Commercial |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$422.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$422.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$485.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$479.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.80
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.80
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$485.35
|
| Rate for Payer: United Healthcare Commercial |
$542.45
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$938.08
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
4506232401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.48 |
| Max. Negotiated Rate |
$891.18 |
| Rate for Payer: Aetna of VT Commercial |
$891.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$840.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$415.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$840.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$564.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$797.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$759.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$422.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$745.77
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cigna Commercial |
$750.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$750.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$750.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$422.14
|
| Rate for Payer: Multiplan Commercial |
$872.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$797.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$422.14
|
| Rate for Payer: United Healthcare Commercial |
$891.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$422.14
|
| Rate for Payer: United Healthcare VA CCN |
$422.14
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
9826232401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$536.74 |
| Rate for Payer: Aetna of VT Commercial |
$536.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$511.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.31
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cash Price |
$285.50
|
| Rate for Payer: Cigna Commercial |
$116.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.34
|
| Rate for Payer: Multiplan Commercial |
$531.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare Commercial |
$128.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.73
|
| Rate for Payer: United Healthcare VA CCN |
$83.73
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$938.08
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
4506232401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$694.27 |
| Max. Negotiated Rate |
$891.18 |
| Rate for Payer: Aetna of VT Commercial |
$891.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$694.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$797.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.46
|
| Rate for Payer: Cash Price |
$469.04
|
| Rate for Payer: Cigna Commercial |
$750.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$750.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$750.46
|
| Rate for Payer: Multiplan Commercial |
$872.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$797.37
|
| Rate for Payer: United Healthcare Commercial |
$891.18
|
|
|
NK CELLS TOTAL COUNT
|
Facility
|
IP
|
$97.41
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
3008635701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna of VT Commercial |
$92.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.93
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna Commercial |
$77.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.93
|
| Rate for Payer: Multiplan Commercial |
$90.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$92.54
|
|
|
NK CELLS TOTAL COUNT
|
Professional
|
Both
|
$97.41
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
3008635701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$185.91 |
| Rate for Payer: Aetna of VT Commercial |
$91.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.13
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$90.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$37.73
|
|
|
NK CELLS TOTAL COUNT
|
Facility
|
OP
|
$97.41
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
3008635701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$185.91 |
| Rate for Payer: Aetna of VT Commercial |
$92.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.44
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cash Price |
$48.70
|
| Rate for Payer: Cigna Commercial |
$77.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.83
|
| Rate for Payer: Multiplan Commercial |
$90.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.83
|
| Rate for Payer: United Healthcare Commercial |
$92.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$43.83
|
|
|
NM ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 78278 26
|
| Hospital Charge Code |
9727827801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.80
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
|
|
NM ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 78278 26
|
| Hospital Charge Code |
9727827801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.09
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.45
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare VA CCN |
$63.45
|
|
|
NM ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
IP
|
$2,425.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,795.30 |
| Max. Negotiated Rate |
$2,304.47 |
| Rate for Payer: Aetna of VT Commercial |
$2,304.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,795.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,795.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,061.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,037.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,940.61
|
| Rate for Payer: Cash Price |
$1,212.88
|
| Rate for Payer: Cigna Commercial |
$1,940.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,940.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,940.61
|
| Rate for Payer: Multiplan Commercial |
$2,255.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,061.90
|
| Rate for Payer: United Healthcare Commercial |
$2,304.47
|
|
|
NM ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
OP
|
$2,425.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,074.37 |
| Max. Negotiated Rate |
$2,304.47 |
| Rate for Payer: Aetna of VT Commercial |
$2,304.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,182.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,074.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,182.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,460.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,061.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,964.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,091.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,928.48
|
| Rate for Payer: Cash Price |
$1,212.88
|
| Rate for Payer: Cash Price |
$1,212.88
|
| Rate for Payer: Cigna Commercial |
$1,940.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,940.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,940.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,091.59
|
| Rate for Payer: Multiplan Commercial |
$2,255.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,061.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,091.59
|
| Rate for Payer: United Healthcare Commercial |
$2,304.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,091.59
|
| Rate for Payer: United Healthcare VA CCN |
$1,091.59
|
|
|
NM ACUTE GI BLOOD LOSS IMAGING
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 78278 26
|
| Hospital Charge Code |
9727827801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$1,182.23 |
| Rate for Payer: Aetna of VT Commercial |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,182.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,182.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.78
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$66.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.61
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$67.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare VA CCN |
$43.61
|
|
|
NM BLD POOL PLANAR REST/STRESS
|
Facility
|
OP
|
$2,116.45
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$715.92 |
| Max. Negotiated Rate |
$2,010.63 |
| Rate for Payer: Aetna of VT Commercial |
$2,010.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$715.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$937.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$715.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,274.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,798.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,714.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$952.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,682.58
|
| Rate for Payer: Cash Price |
$1,058.22
|
| Rate for Payer: Cash Price |
$1,058.22
|
| Rate for Payer: Cigna Commercial |
$1,693.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,693.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,693.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$952.40
|
| Rate for Payer: Multiplan Commercial |
$1,968.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,798.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$952.40
|
| Rate for Payer: United Healthcare Commercial |
$2,010.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$952.40
|
| Rate for Payer: United Healthcare VA CCN |
$952.40
|
|
|
NM BLD POOL PLANAR REST/STRESS
|
Facility
|
IP
|
$2,116.45
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
3417847201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$2,010.63 |
| Rate for Payer: Aetna of VT Commercial |
$2,010.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,566.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,566.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,798.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,777.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,693.16
|
| Rate for Payer: Cash Price |
$1,058.22
|
| Rate for Payer: Cigna Commercial |
$1,693.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,693.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,693.16
|
| Rate for Payer: Multiplan Commercial |
$1,968.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,798.98
|
| Rate for Payer: United Healthcare Commercial |
$2,010.63
|
|
