|
NON-ROUTINE BL DRAW 3/> YRS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9823641001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
NON-ROUTINE BL DRAW 3/> YRS
|
Professional
|
Both
|
$42.39
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
3003641001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna of VT Commercial |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.79
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$15.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$12.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$8.41
|
|
|
NON-ROUTINE BL DRAW 3/> YRS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9823641001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare VA CCN |
$16.20
|
|
|
NON-ROUTINE BL DRAW 3/> YRS
|
Facility
|
IP
|
$42.39
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
3003641001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.91
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
|
|
NON-ROUTINE BL DRAW 3/> YRS
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
9823641001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna of VT Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.79
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$15.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$12.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$8.41
|
|
|
NON-ROUTINE BL DRAW 3/> YRS
|
Facility
|
OP
|
$42.39
|
|
|
Service Code
|
CPT 36410
|
| Hospital Charge Code |
3003641001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna of VT Commercial |
$40.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.70
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna Commercial |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$39.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$40.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare VA CCN |
$19.08
|
|
|
NOSE BLEED TRAY
|
Facility
|
OP
|
$8.21
|
|
| Hospital Charge Code |
2720066792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of VT Commercial |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.53
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cigna Commercial |
$6.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$7.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.69
|
| Rate for Payer: United Healthcare Commercial |
$7.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.69
|
| Rate for Payer: United Healthcare VA CCN |
$3.69
|
|
|
NOSE BLEED TRAY
|
Facility
|
IP
|
$8.21
|
|
| Hospital Charge Code |
2720066792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of VT Commercial |
$7.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.57
|
| Rate for Payer: Cash Price |
$4.11
|
| Rate for Payer: Cigna Commercial |
$6.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.57
|
| Rate for Payer: Multiplan Commercial |
$7.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.98
|
| Rate for Payer: United Healthcare Commercial |
$7.80
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$231.57 |
| Max. Negotiated Rate |
$1,357.36 |
| Rate for Payer: Aetna of VT Commercial |
$1,357.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$627.57
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$352.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.57
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare Commercial |
$356.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare VA CCN |
$231.57
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$656.33
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9229591202
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$485.75 |
| Max. Negotiated Rate |
$623.51 |
| Rate for Payer: Aetna of VT Commercial |
$623.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$485.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$485.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$557.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$551.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$525.06
|
| Rate for Payer: Cash Price |
$328.16
|
| Rate for Payer: Cigna Commercial |
$525.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$525.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$525.06
|
| Rate for Payer: Multiplan Commercial |
$610.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$557.88
|
| Rate for Payer: United Healthcare Commercial |
$623.51
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$307.37 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna of VT Commercial |
$659.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$551.73
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.30
|
| Rate for Payer: Multiplan Commercial |
$645.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.30
|
| Rate for Payer: United Healthcare Commercial |
$659.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.30
|
| Rate for Payer: United Healthcare VA CCN |
$312.30
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$231.57 |
| Max. Negotiated Rate |
$652.36 |
| Rate for Payer: Aetna of VT Commercial |
$652.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$621.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$627.57
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$352.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.57
|
| Rate for Payer: Multiplan Commercial |
$645.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare Commercial |
$356.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare VA CCN |
$231.57
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Professional
|
Both
|
$656.33
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9229591202
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$231.57 |
| Max. Negotiated Rate |
$627.57 |
| Rate for Payer: Aetna of VT Commercial |
$616.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$588.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$588.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$627.57
|
| Rate for Payer: Cash Price |
$328.16
|
| Rate for Payer: Cash Price |
$328.16
|
| Rate for Payer: Cigna Commercial |
$352.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.57
|
| Rate for Payer: Multiplan Commercial |
$610.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$328.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare Commercial |
$356.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.57
|
| Rate for Payer: United Healthcare VA CCN |
$231.57
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$639.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,293.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$869.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,169.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$649.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,147.98
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$649.80
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$649.80
|
| Rate for Payer: United Healthcare VA CCN |
$649.80
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$513.63 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna of VT Commercial |
$659.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$513.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$513.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.20
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.20
|
| Rate for Payer: Multiplan Commercial |
$645.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.90
|
| Rate for Payer: United Healthcare Commercial |
$659.30
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9609591201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,068.70 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,068.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,227.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,212.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,155.20
|
| Rate for Payer: Cash Price |
$722.00
|
| Rate for Payer: Cigna Commercial |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,155.20
|
| Rate for Payer: Multiplan Commercial |
$1,342.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,227.40
|
| Rate for Payer: United Healthcare Commercial |
$1,371.80
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$656.33
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
9229591202
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$290.69 |
| Max. Negotiated Rate |
$623.51 |
| Rate for Payer: Aetna of VT Commercial |
$623.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$588.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$290.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$588.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$395.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$557.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$521.78
|
| Rate for Payer: Cash Price |
$328.16
|
| Rate for Payer: Cigna Commercial |
$525.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$525.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$525.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$295.35
|
| Rate for Payer: Multiplan Commercial |
$610.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$557.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$295.35
|
| Rate for Payer: United Healthcare Commercial |
$623.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.35
|
| Rate for Payer: United Healthcare VA CCN |
$295.35
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Professional
|
Both
|
$3,111.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.21 |
| Max. Negotiated Rate |
$2,924.34 |
| Rate for Payer: Aetna of VT Commercial |
$2,924.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,787.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,787.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$311.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$726.17
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cigna Commercial |
$406.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$271.22
|
| Rate for Payer: Multiplan Commercial |
$2,893.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare Commercial |
$417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare VA CCN |
$271.21
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.21 |
| Max. Negotiated Rate |
$726.17 |
| Rate for Payer: Aetna of VT Commercial |
$703.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$670.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$670.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$311.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$726.17
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$406.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$271.22
|
| Rate for Payer: Multiplan Commercial |
$695.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare Commercial |
$417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare VA CCN |
$271.21
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$646.56
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9229591302
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$478.52 |
| Max. Negotiated Rate |
$614.23 |
| Rate for Payer: Aetna of VT Commercial |
$614.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$478.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$478.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.25
|
| Rate for Payer: Cash Price |
$323.28
|
| Rate for Payer: Cigna Commercial |
$517.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.25
|
| Rate for Payer: Multiplan Commercial |
$601.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.58
|
| Rate for Payer: United Healthcare Commercial |
$614.23
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$331.29 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna of VT Commercial |
$710.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$670.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$331.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$670.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$450.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$635.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$605.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$594.66
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$598.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$598.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$598.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.60
|
| Rate for Payer: Multiplan Commercial |
$695.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$710.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.60
|
| Rate for Payer: United Healthcare VA CCN |
$336.60
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Professional
|
Both
|
$646.56
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9229591302
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$271.21 |
| Max. Negotiated Rate |
$726.17 |
| Rate for Payer: Aetna of VT Commercial |
$607.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$579.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$279.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$579.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$726.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$311.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$726.17
|
| Rate for Payer: Cash Price |
$323.28
|
| Rate for Payer: Cash Price |
$323.28
|
| Rate for Payer: Cigna Commercial |
$406.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$271.22
|
| Rate for Payer: Multiplan Commercial |
$601.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare Commercial |
$417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.21
|
| Rate for Payer: United Healthcare VA CCN |
$271.21
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$646.56
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9229591302
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$286.36 |
| Max. Negotiated Rate |
$614.23 |
| Rate for Payer: Aetna of VT Commercial |
$614.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$579.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$286.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$579.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$389.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$523.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$290.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.02
|
| Rate for Payer: Cash Price |
$323.28
|
| Rate for Payer: Cigna Commercial |
$517.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.95
|
| Rate for Payer: Multiplan Commercial |
$601.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.95
|
| Rate for Payer: United Healthcare Commercial |
$614.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.95
|
| Rate for Payer: United Healthcare VA CCN |
$290.95
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,302.45 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,955.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,302.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,302.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,644.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,613.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,488.80
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cigna Commercial |
$2,488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,488.80
|
| Rate for Payer: Multiplan Commercial |
$2,893.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,644.35
|
| Rate for Payer: United Healthcare Commercial |
$2,955.45
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,377.86 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,955.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,787.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,377.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,787.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,872.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,644.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,519.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,399.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,473.24
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cigna Commercial |
$2,488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,399.95
|
| Rate for Payer: Multiplan Commercial |
$2,893.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,644.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,399.95
|
| Rate for Payer: United Healthcare Commercial |
$2,955.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,399.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,399.95
|
|
