|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
9609591302
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$553.59 |
| 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 |
$553.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$553.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$635.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$598.40
|
| 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: Multiplan Commercial |
$695.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$635.80
|
| Rate for Payer: United Healthcare Commercial |
$710.60
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
OP
|
$491.15
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9229591002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$466.59 |
| Rate for Payer: Aetna of VT Commercial |
$466.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$295.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$397.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$390.46
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$392.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.02
|
| Rate for Payer: United Healthcare Commercial |
$466.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.02
|
| Rate for Payer: United Healthcare VA CCN |
$221.02
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$450.26 |
| Rate for Payer: Aetna of VT Commercial |
$450.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.10
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$445.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare Commercial |
$255.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare VA CCN |
$165.93
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,107.19 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,256.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,196.80
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Professional
|
Both
|
$491.15
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9229591002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$461.68 |
| Rate for Payer: Aetna of VT Commercial |
$461.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.10
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare Commercial |
$255.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare VA CCN |
$165.93
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
IP
|
$491.15
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9229591002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$466.59 |
| Rate for Payer: Aetna of VT Commercial |
$466.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$363.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$363.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.92
|
| Rate for Payer: Cash Price |
$245.57
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$392.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$392.92
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$417.48
|
| Rate for Payer: United Healthcare Commercial |
$466.59
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$354.51 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna of VT Commercial |
$455.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$354.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$354.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$407.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.20
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$383.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$383.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$383.20
|
| Rate for Payer: Multiplan Commercial |
$445.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$407.15
|
| Rate for Payer: United Healthcare Commercial |
$455.05
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$1,406.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,406.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$443.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.10
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$266.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$266.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare Commercial |
$255.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare VA CCN |
$165.93
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$662.58 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$662.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$900.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,211.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,189.32
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$673.20
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare VA CCN |
$673.20
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
9609591002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$212.15 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna of VT Commercial |
$455.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$212.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$288.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$407.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$387.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.81
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna Commercial |
$383.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$383.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$383.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$215.55
|
| Rate for Payer: Multiplan Commercial |
$445.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$407.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$215.55
|
| Rate for Payer: United Healthcare Commercial |
$455.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$215.55
|
| Rate for Payer: United Healthcare VA CCN |
$215.55
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$258.21 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Aetna of VT Commercial |
$553.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$522.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$258.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$522.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$350.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$495.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$472.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$262.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$463.49
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cigna Commercial |
$466.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$466.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$466.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$262.35
|
| Rate for Payer: Multiplan Commercial |
$542.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$495.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$262.35
|
| Rate for Payer: United Healthcare Commercial |
$553.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.35
|
| Rate for Payer: United Healthcare VA CCN |
$262.35
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Professional
|
Both
|
$3,030.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$198.98 |
| Max. Negotiated Rate |
$2,848.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,848.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,714.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,714.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$536.48
|
| Rate for Payer: Cash Price |
$1,515.00
|
| Rate for Payer: Cash Price |
$1,515.00
|
| Rate for Payer: Cigna Commercial |
$301.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.99
|
| Rate for Payer: Multiplan Commercial |
$2,817.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare Commercial |
$306.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare VA CCN |
$198.98
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
OP
|
$930.60
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9229591102
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$412.16 |
| Max. Negotiated Rate |
$884.07 |
| Rate for Payer: Aetna of VT Commercial |
$884.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$833.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$412.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$833.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$560.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$791.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$753.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$418.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.83
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$744.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$418.77
|
| Rate for Payer: Multiplan Commercial |
$865.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$791.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$418.77
|
| Rate for Payer: United Healthcare Commercial |
$884.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$418.77
|
| Rate for Payer: United Healthcare VA CCN |
$418.77
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
OP
|
$3,030.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,341.99 |
| Max. Negotiated Rate |
$2,878.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,878.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,714.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,341.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,714.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,575.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,454.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,363.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,408.85
|
| Rate for Payer: Cash Price |
$1,515.00
|
| Rate for Payer: Cigna Commercial |
$2,424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,424.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,363.50
|
| Rate for Payer: Multiplan Commercial |
$2,817.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,575.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,363.50
|
| Rate for Payer: United Healthcare Commercial |
$2,878.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,363.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,363.50
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
IP
|
$3,030.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,242.50 |
| Max. Negotiated Rate |
$2,878.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,878.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,242.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,575.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,545.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,424.00
|
| Rate for Payer: Cash Price |
$1,515.00
|
| Rate for Payer: Cigna Commercial |
$2,424.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,424.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,424.00
|
| Rate for Payer: Multiplan Commercial |
$2,817.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,575.50
|
| Rate for Payer: United Healthcare Commercial |
$2,878.50
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$431.48 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Aetna of VT Commercial |
$553.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$431.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$431.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$495.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$489.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$466.40
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cigna Commercial |
$466.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$466.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$466.40
|
| Rate for Payer: Multiplan Commercial |
$542.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$495.55
|
| Rate for Payer: United Healthcare Commercial |
$553.85
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Professional
|
Both
|
$930.60
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9229591102
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$198.98 |
| Max. Negotiated Rate |
$874.76 |
| Rate for Payer: Aetna of VT Commercial |
$874.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$833.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$833.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$536.48
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$301.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.99
|
| Rate for Payer: Multiplan Commercial |
$865.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare Commercial |
$306.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare VA CCN |
$198.98
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9609591102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$198.98 |
| Max. Negotiated Rate |
$548.02 |
| Rate for Payer: Aetna of VT Commercial |
$548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$522.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$204.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$522.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$536.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$228.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$536.48
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cash Price |
$291.50
|
| Rate for Payer: Cigna Commercial |
$301.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.99
|
| Rate for Payer: Multiplan Commercial |
$542.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$282.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare Commercial |
$306.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.98
|
| Rate for Payer: United Healthcare VA CCN |
$198.98
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
IP
|
$930.60
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
9229591102
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$688.74 |
| Max. Negotiated Rate |
$884.07 |
| Rate for Payer: Aetna of VT Commercial |
$884.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$688.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$688.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$791.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$781.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.48
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna Commercial |
$744.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$744.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$744.48
|
| Rate for Payer: Multiplan Commercial |
$865.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$791.01
|
| Rate for Payer: United Healthcare Commercial |
$884.07
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Professional
|
Both
|
$222.31
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9229590802
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$105.51 |
| Max. Negotiated Rate |
$283.08 |
| Rate for Payer: Aetna of VT Commercial |
$208.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.08
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cigna Commercial |
$159.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.51
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.51
|
| Rate for Payer: United Healthcare Commercial |
$162.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.51
|
| Rate for Payer: United Healthcare VA CCN |
$105.51
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9609590801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$283.08 |
| Rate for Payer: Aetna of VT Commercial |
$102.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.08
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$159.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.51
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.51
|
| Rate for Payer: United Healthcare Commercial |
$162.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.51
|
| Rate for Payer: United Healthcare VA CCN |
$105.51
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9609590801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.20
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9609590801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.66
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.05
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare VA CCN |
$49.05
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9609590802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.20
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
9609590802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.66
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.05
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare VA CCN |
$49.05
|
|
