|
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
|
|
|
NURSING FAC CARE/DAY INIT 35 M
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
9699930501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$207.23 |
| 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 |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.00
|
| 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: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
|
|
NURSING FAC CARE/DAY INIT 45 M
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
9699930601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$278.75 |
| Rate for Payer: Aetna of VT Commercial |
$266.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$240.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$237.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$237.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.44
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$186.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.50
|
| Rate for Payer: United Healthcare Commercial |
$263.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.50
|
| Rate for Payer: United Healthcare VA CCN |
$171.50
|
|
|
NURSING FAC CARE/DAY INIT 45 M
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
9699930601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$210.19 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.20
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
|
|
NURSING FAC CARE/DAY INIT 45 M
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
9699930601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$125.78 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna of VT Commercial |
$269.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$254.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$225.78
|
| Rate for Payer: Cash Price |
$142.00
|
| Rate for Payer: Cigna Commercial |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$227.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$227.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.80
|
| Rate for Payer: Multiplan Commercial |
$264.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare Commercial |
$269.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare VA CCN |
$127.80
|
|
|
NURSING FAC DISCH MGMT > 30M
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9699931601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$123.05 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna of VT Commercial |
$192.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$126.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$141.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.93
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$134.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.06
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.05
|
| Rate for Payer: United Healthcare Commercial |
$189.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.05
|
| Rate for Payer: United Healthcare VA CCN |
$123.05
|
|
|
NURSING FAC DISCH MGMT > 30M
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9699931601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna of VT Commercial |
$194.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.00
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.25
|
| Rate for Payer: United Healthcare Commercial |
$194.75
|
|
|
NURSING FAC DISCH MGMT > 30M
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
9699931601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna of VT Commercial |
$194.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.97
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$190.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$194.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.25
|
| Rate for Payer: United Healthcare VA CCN |
$92.25
|
|
|
NURSING FAC DISCH MGMT 30M/<
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9699931501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna of VT Commercial |
$130.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.60
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.60
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.45
|
| Rate for Payer: United Healthcare Commercial |
$130.15
|
|
|
NURSING FAC DISCH MGMT 30M/<
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9699931501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$60.68 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna of VT Commercial |
$130.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.92
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.65
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.65
|
| Rate for Payer: United Healthcare Commercial |
$130.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.65
|
| Rate for Payer: United Healthcare VA CCN |
$61.65
|
|
|
NURSING FAC DISCH MGMT 30M/<
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
9699931501
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$128.78 |
| Rate for Payer: Aetna of VT Commercial |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.98
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$83.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.85
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.85
|
| Rate for Payer: United Healthcare Commercial |
$118.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.85
|
| Rate for Payer: United Healthcare VA CCN |
$76.85
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$226.26 |
| Rate for Payer: Aetna of VT Commercial |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.26
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$128.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.58
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare Commercial |
$130.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare VA CCN |
$84.58
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.40
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.03
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare VA CCN |
$32.85
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Professional
|
Both
|
$146.31
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9229590702
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$84.58 |
| Max. Negotiated Rate |
$226.26 |
| Rate for Payer: Aetna of VT Commercial |
$137.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.26
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cigna Commercial |
$128.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.58
|
| Rate for Payer: Multiplan Commercial |
$136.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare Commercial |
$130.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare VA CCN |
$84.58
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.40
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.03
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare VA CCN |
$32.85
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
IP
|
$146.31
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9229590702
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna of VT Commercial |
$138.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.05
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cigna Commercial |
$117.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.05
|
| Rate for Payer: Multiplan Commercial |
$136.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.36
|
| Rate for Payer: United Healthcare Commercial |
$138.99
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
OP
|
$146.31
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9229590702
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna of VT Commercial |
$138.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.32
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cigna Commercial |
$117.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.84
|
| Rate for Payer: Multiplan Commercial |
$136.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.84
|
| Rate for Payer: United Healthcare Commercial |
$138.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.84
|
| Rate for Payer: United Healthcare VA CCN |
$65.84
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
9609590702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$226.26 |
| Rate for Payer: Aetna of VT Commercial |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.26
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$128.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.58
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare Commercial |
$130.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.58
|
| Rate for Payer: United Healthcare VA CCN |
$84.58
|
|
|
NYSTATIN ORAL SUSP 5 ML
|
Facility
|
IP
|
$6.14
|
|
| Hospital Charge Code |
2500000582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of VT Commercial |
$5.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.91
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
|
|
NYSTATIN ORAL SUSP 5 ML
|
Facility
|
OP
|
$6.14
|
|
| Hospital Charge Code |
2500000582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of VT Commercial |
$5.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.88
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.76
|
| Rate for Payer: United Healthcare VA CCN |
$2.76
|
|
|
NYSTATIN ORAL SUSP 5 ML
|
Facility
|
OP
|
$6.14
|
|
|
Service Code
|
NDC 904727692
|
| Hospital Charge Code |
2500000582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of VT Commercial |
$5.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.88
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.76
|
| Rate for Payer: United Healthcare VA CCN |
$2.76
|
|
|
NYSTATIN ORAL SUSP 5 ML
|
Facility
|
IP
|
$6.14
|
|
|
Service Code
|
NDC 904727692
|
| Hospital Charge Code |
2500000582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of VT Commercial |
$5.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.91
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$5.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
|
|
OB ANTEP CESAREAN DLVR & POSTP
|
Facility
|
OP
|
$5,152.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
9695951001
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$2,281.82 |
| Max. Negotiated Rate |
$4,894.40 |
| Rate for Payer: Aetna of VT Commercial |
$4,894.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,615.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,281.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,615.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,101.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,379.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,173.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,318.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,095.84
|
| Rate for Payer: Cash Price |
$2,576.00
|
| Rate for Payer: Cigna Commercial |
$4,121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,121.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,318.40
|
| Rate for Payer: Multiplan Commercial |
$4,791.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,379.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,318.40
|
| Rate for Payer: United Healthcare Commercial |
$4,894.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,318.40
|
| Rate for Payer: United Healthcare VA CCN |
$2,318.40
|
|
