|
STREP B DNA AMP PROBE
|
Professional
|
Both
|
$161.30
|
|
|
Service Code
|
CPT 87653
|
| Hospital Charge Code |
3008765301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$151.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.98
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$150.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
STREP B DNA AMP PROBE
|
Facility
|
OP
|
$161.30
|
|
|
Service Code
|
CPT 87653
|
| Hospital Charge Code |
3008765301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$153.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.23
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cigna Commercial |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.58
|
| Rate for Payer: Multiplan Commercial |
$150.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$153.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$72.58
|
|
|
STRESS TTE COMPLETE
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
5109335101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,718.51 |
| Max. Negotiated Rate |
$2,205.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,205.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,718.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,718.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,973.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,950.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,857.60
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,857.60
|
| Rate for Payer: Multiplan Commercial |
$2,159.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,973.70
|
| Rate for Payer: United Healthcare Commercial |
$2,205.90
|
|
|
STRESS TTE COMPLETE
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
5109335101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,028.41 |
| Max. Negotiated Rate |
$2,205.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,205.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,080.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,028.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,080.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,397.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,973.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,880.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,044.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,845.99
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,857.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,857.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,044.90
|
| Rate for Payer: Multiplan Commercial |
$2,159.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,973.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,044.90
|
| Rate for Payer: United Healthcare Commercial |
$2,205.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,044.90
|
| Rate for Payer: United Healthcare VA CCN |
$1,044.90
|
|
|
STRESS TTE COMPLETE
|
Facility
|
OP
|
$3,190.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,412.85 |
| Max. Negotiated Rate |
$3,030.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,857.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,412.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,857.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,920.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,583.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,435.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,536.05
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,552.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,552.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,552.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,435.50
|
| Rate for Payer: Multiplan Commercial |
$2,966.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,435.50
|
| Rate for Payer: United Healthcare Commercial |
$3,030.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,435.50
|
|
|
STRESS TTE COMPLETE
|
Professional
|
Both
|
$2,322.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
5109335101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$2,182.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,182.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,080.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,080.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.12
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cash Price |
$1,161.00
|
| Rate for Payer: Cigna Commercial |
$514.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$2,159.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare Commercial |
$338.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare VA CCN |
$220.00
|
|
|
STRESS TTE COMPLETE
|
Facility
|
IP
|
$3,190.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,360.92 |
| Max. Negotiated Rate |
$3,030.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,360.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,360.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,679.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,552.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,552.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,552.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,552.00
|
| Rate for Payer: Multiplan Commercial |
$2,966.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.50
|
| Rate for Payer: United Healthcare Commercial |
$3,030.50
|
|
|
STRESS TTE COMPLETE
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$816.86 |
| Rate for Payer: Aetna of VT Commercial |
$816.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.12
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$514.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare Commercial |
$338.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare VA CCN |
$220.00
|
|
|
STRESS TTE COMPLETE
|
Facility
|
IP
|
$2,150.60
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
4839335101
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,591.66 |
| Max. Negotiated Rate |
$2,043.07 |
| Rate for Payer: Aetna of VT Commercial |
$2,043.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,591.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,591.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,828.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,806.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,720.48
|
| Rate for Payer: Cash Price |
$1,075.30
|
| Rate for Payer: Cigna Commercial |
$1,720.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,720.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,720.48
|
| Rate for Payer: Multiplan Commercial |
$2,000.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,828.01
|
| Rate for Payer: United Healthcare Commercial |
$2,043.07
|
|
|
STRESS TTE COMPLETE
|
Facility
|
OP
|
$2,150.60
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
4839335101
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$2,043.07 |
| Rate for Payer: Aetna of VT Commercial |
$2,043.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,926.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,926.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,294.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,828.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,741.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$967.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,709.73
|
| Rate for Payer: Cash Price |
$1,075.30
|
| Rate for Payer: Cigna Commercial |
$1,720.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,720.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,720.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$967.77
|
| Rate for Payer: Multiplan Commercial |
$2,000.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,828.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$967.77
|
| Rate for Payer: United Healthcare Commercial |
$2,043.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$967.77
|
| Rate for Payer: United Healthcare VA CCN |
$967.77
|
|
|
STRESS TTE COMPLETE
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$2,998.60 |
| Rate for Payer: Aetna of VT Commercial |
$2,998.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,857.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,857.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.12
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$514.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$2,966.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare Commercial |
$338.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare VA CCN |
$220.00
|
|
|
STRESS TTE COMPLETE
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
4839335101
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$816.86 |
| Rate for Payer: Aetna of VT Commercial |
$816.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.12
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$514.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare Commercial |
$338.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.00
|
| Rate for Payer: United Healthcare VA CCN |
$220.00
|
|
|
STRESS TTE COMPLETE
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$643.15 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna of VT Commercial |
$825.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$643.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$643.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$695.20
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$695.20
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.65
|
| Rate for Payer: United Healthcare Commercial |
$825.55
|
|
|
STRESS TTE COMPLETE
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
9609335102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$384.88 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna of VT Commercial |
$825.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$778.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$523.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$738.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$391.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$690.86
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$695.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$695.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$391.05
|
| Rate for Payer: Multiplan Commercial |
$808.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$738.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$391.05
|
| Rate for Payer: United Healthcare Commercial |
$825.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.05
|
| Rate for Payer: United Healthcare VA CCN |
$391.05
|
|
|
STRESS TTE ONLY
|
Facility
|
IP
|
$779.64
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4809335001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$577.01 |
| Max. Negotiated Rate |
$740.66 |
| Rate for Payer: Aetna of VT Commercial |
$740.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$654.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$623.71
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cigna Commercial |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.71
|
| Rate for Payer: Multiplan Commercial |
$725.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.69
|
| Rate for Payer: United Healthcare Commercial |
$740.66
|
|
|
STRESS TTE ONLY
|
Professional
|
Both
|
$779.64
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4809335001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$175.11 |
| Max. Negotiated Rate |
$732.86 |
| Rate for Payer: Aetna of VT Commercial |
$732.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$245.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.01
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.11
|
| Rate for Payer: Multiplan Commercial |
$725.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.11
|
| Rate for Payer: United Healthcare Commercial |
$269.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.11
|
| Rate for Payer: United Healthcare VA CCN |
$175.11
|
|
|
STRESS TTE ONLY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
9729335001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.03
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare VA CCN |
$87.75
|
|
|
STRESS TTE ONLY
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
9729335001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$174.70 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna of VT Commercial |
$183.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$245.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$302.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.01
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.11
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.11
|
| Rate for Payer: United Healthcare Commercial |
$269.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.11
|
| Rate for Payer: United Healthcare VA CCN |
$175.11
|
|
|
STRESS TTE ONLY
|
Facility
|
OP
|
$779.64
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4809335001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$345.30 |
| Max. Negotiated Rate |
$740.66 |
| Rate for Payer: Aetna of VT Commercial |
$740.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$469.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$631.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$619.81
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cigna Commercial |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$350.84
|
| Rate for Payer: Multiplan Commercial |
$725.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.84
|
| Rate for Payer: United Healthcare Commercial |
$740.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.84
|
| Rate for Payer: United Healthcare VA CCN |
$350.84
|
|
|
STRESS TTE ONLY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
9729335001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
|
|
SUBQ OBSERVATION CARE 35M
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
9829922601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$88.14 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Aetna of VT Commercial |
$189.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$158.21
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$159.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.55
|
| Rate for Payer: Multiplan Commercial |
$185.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.55
|
| Rate for Payer: United Healthcare Commercial |
$189.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.55
|
| Rate for Payer: United Healthcare VA CCN |
$89.55
|
|
|
SUBQ OBSERVATION CARE 35M
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
9829922601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$187.06 |
| Rate for Payer: Aetna of VT Commercial |
$187.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.28
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$185.07
|
| Rate for Payer: United Healthcare Commercial |
$169.15
|
| Rate for Payer: United Healthcare VA CCN |
$79.60
|
|
|
SUBQ OBSERVATION CARE 35M
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
9829922601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Aetna of VT Commercial |
$189.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$147.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$147.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$169.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.20
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$159.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$159.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$185.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.15
|
| Rate for Payer: United Healthcare Commercial |
$189.05
|
|
|
SUGAMMADEX 200 MG/2 ML VIAL
|
Facility
|
IP
|
$17.66
|
|
|
Service Code
|
NDC 6542312
|
| Hospital Charge Code |
636J349010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna of VT Commercial |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$13.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$13.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.13
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cigna Commercial |
$14.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.13
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.01
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
|
|
SUGAMMADEX 200 MG/2 ML VIAL
|
Facility
|
OP
|
$17.66
|
|
|
Service Code
|
NDC 6542312
|
| Hospital Charge Code |
636J349010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna of VT Commercial |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.04
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cigna Commercial |
$14.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare VA CCN |
$7.95
|
|
