|
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 |
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
|
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 5-6 STUDIES
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$279.76 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Professional
|
Both
|
$389.11
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9229590902
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna of VT Commercial |
$365.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.65
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna Commercial |
$191.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.94
|
| Rate for Payer: Multiplan Commercial |
$361.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare VA CCN |
$126.93
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
OP
|
$389.11
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9229590902
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$172.34 |
| Max. Negotiated Rate |
$369.65 |
| Rate for Payer: Aetna of VT Commercial |
$369.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.34
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna Commercial |
$311.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.10
|
| Rate for Payer: Multiplan Commercial |
$361.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.10
|
| Rate for Payer: United Healthcare Commercial |
$369.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.10
|
| Rate for Payer: United Healthcare VA CCN |
$175.10
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$872.58 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$943.20
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
IP
|
$389.11
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9229590902
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.98 |
| Max. Negotiated Rate |
$369.65 |
| Rate for Payer: Aetna of VT Commercial |
$369.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.29
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cigna Commercial |
$311.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.29
|
| Rate for Payer: Multiplan Commercial |
$361.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.74
|
| Rate for Payer: United Healthcare Commercial |
$369.65
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna of VT Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.51
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare Commercial |
$359.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.10
|
| Rate for Payer: United Healthcare VA CCN |
$170.10
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$1,108.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,108.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.65
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$191.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.94
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare VA CCN |
$126.93
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna of VT Commercial |
$355.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.65
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$191.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.94
|
| Rate for Payer: Multiplan Commercial |
$351.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.93
|
| Rate for Payer: United Healthcare VA CCN |
$126.93
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
9609590901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$522.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$709.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$954.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$530.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$937.30
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.55
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare VA CCN |
$530.55
|
|
|
NS 2000 ML IRR SOLUTION
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
NS 2000 ML IRR SOLUTION
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 338004746
|
| Hospital Charge Code |
2500000566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
NS 2000 ML IRR SOLUTION
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000566
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
NS 2000 ML IRR SOLUTION
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 338004746
|
| Hospital Charge Code |
2500000566
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
NS W 40 MEQ KCI/L
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
2500000565
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
NS W 40 MEQ KCI/L
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
2500000565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
NUCLEAR ANTIGEN ANTIBODY
|
Facility
|
IP
|
$235.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3008623501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$223.28 |
| Rate for Payer: Aetna of VT Commercial |
$223.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$197.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.02
|
| Rate for Payer: Cash Price |
$117.52
|
| Rate for Payer: Cigna Commercial |
$188.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.02
|
| Rate for Payer: Multiplan Commercial |
$218.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.78
|
| Rate for Payer: United Healthcare Commercial |
$223.28
|
|
|
NUCLEAR ANTIGEN ANTIBODY
|
Professional
|
Both
|
$235.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3008623501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$220.93 |
| Rate for Payer: Aetna of VT Commercial |
$220.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.65
|
| Rate for Payer: Cash Price |
$117.52
|
| Rate for Payer: Cash Price |
$117.52
|
| Rate for Payer: Cigna Commercial |
$21.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$218.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare VA CCN |
$17.93
|
|
|
NUCLEAR ANTIGEN ANTIBODY
|
Facility
|
OP
|
$235.03
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3008623501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$223.28 |
| Rate for Payer: Aetna of VT Commercial |
$223.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.85
|
| Rate for Payer: Cash Price |
$117.52
|
| Rate for Payer: Cash Price |
$117.52
|
| Rate for Payer: Cigna Commercial |
$188.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.76
|
| Rate for Payer: Multiplan Commercial |
$218.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.76
|
| Rate for Payer: United Healthcare Commercial |
$223.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare VA CCN |
$105.76
|
|
|
NURSING FAC CARE/DAY INIT 25 M
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
9699930401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare VA CCN |
$58.50
|
|
|
NURSING FAC CARE/DAY INIT 25 M
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
9699930401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of VT Commercial |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$82.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.58
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.58
|
| Rate for Payer: United Healthcare Commercial |
$116.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.58
|
| Rate for Payer: United Healthcare VA CCN |
$75.58
|
|
|
NURSING FAC CARE/DAY INIT 25 M
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
9699930401
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
|
|
NURSING FAC CARE/DAY INIT 35 M
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
9699930501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare VA CCN |
$126.00
|
|
