|
SUTURE LARGE INTESTINE
|
Facility
|
OP
|
$2,885.00
|
|
|
Service Code
|
CPT 44604
|
| Hospital Charge Code |
9824460401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,277.77 |
| Max. Negotiated Rate |
$2,740.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,740.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,584.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,277.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,584.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,736.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,452.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,336.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,298.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,293.57
|
| Rate for Payer: Cash Price |
$1,442.50
|
| Rate for Payer: Cigna Commercial |
$2,308.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,308.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,308.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,298.25
|
| Rate for Payer: Multiplan Commercial |
$2,683.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,452.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,298.25
|
| Rate for Payer: United Healthcare Commercial |
$2,740.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,298.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,298.25
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
OP
|
$3,268.00
|
|
|
Service Code
|
CPT 44602
|
| Hospital Charge Code |
9824460201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,104.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,447.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,967.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,777.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,647.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,598.06
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,614.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,470.60
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,777.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,470.60
|
| Rate for Payer: United Healthcare Commercial |
$3,104.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,470.60
|
| Rate for Payer: United Healthcare VA CCN |
$1,470.60
|
|
|
SUTURE SMALL INTESTINE
|
Professional
|
Both
|
$3,268.00
|
|
|
Service Code
|
CPT 44602
|
| Hospital Charge Code |
9824460201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,270.05 |
| Max. Negotiated Rate |
$3,071.92 |
| Rate for Payer: Aetna of VT Commercial |
$3,071.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,308.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,927.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,778.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,741.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,741.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,460.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,741.41
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,325.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,168.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,168.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,270.05
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,803.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,270.05
|
| Rate for Payer: United Healthcare Commercial |
$1,953.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,270.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,270.05
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
IP
|
$3,268.00
|
|
|
Service Code
|
CPT 44602
|
| Hospital Charge Code |
9824460201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,418.65 |
| Max. Negotiated Rate |
$3,104.60 |
| Rate for Payer: Aetna of VT Commercial |
$3,104.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,418.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,418.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,777.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,745.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,614.40
|
| Rate for Payer: Cash Price |
$1,634.00
|
| Rate for Payer: Cigna Commercial |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,614.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,614.40
|
| Rate for Payer: Multiplan Commercial |
$3,039.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,777.80
|
| Rate for Payer: United Healthcare Commercial |
$3,104.60
|
|
|
SUT VIC 2.0 J785G
|
Facility
|
OP
|
$8.89
|
|
| Hospital Charge Code |
2720026391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of VT Commercial |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.07
|
| Rate for Payer: Cash Price |
$4.44
|
| Rate for Payer: Cigna Commercial |
$7.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$8.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$8.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare VA CCN |
$4.00
|
|
|
SUT VIC 2.0 J785G
|
Facility
|
IP
|
$8.89
|
|
| Hospital Charge Code |
2720026391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of VT Commercial |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.11
|
| Rate for Payer: Cash Price |
$4.44
|
| Rate for Payer: Cigna Commercial |
$7.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.11
|
| Rate for Payer: Multiplan Commercial |
$8.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.56
|
| Rate for Payer: United Healthcare Commercial |
$8.45
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 98015
|
| Hospital Charge Code |
9609801501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.49
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.35
|
| Rate for Payer: United Healthcare VA CCN |
$82.35
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
CPT 98015
|
| Hospital Charge Code |
9609801501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna of VT Commercial |
$172.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.30
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$126.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.90
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare VA CCN |
$73.20
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 98015
|
| Hospital Charge Code |
9609801501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$135.44 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Aetna of VT Commercial |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.40
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$146.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$170.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.55
|
| Rate for Payer: United Healthcare Commercial |
$173.85
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 98013
|
| Hospital Charge Code |
9609801301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 98013
|
| Hospital Charge Code |
9609801301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$58.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.38
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 98013
|
| Hospital Charge Code |
9609801301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
SYNCH AUDIO-VIDEO EST LOW 20
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 98005
|
| Hospital Charge Code |
9609800501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
|
SYNCH AUDIO-VIDEO EST LOW 20
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 98005
|
| Hospital Charge Code |
9609800501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$119.40 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$63.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.03
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare VA CCN |
$33.60
|
|
|
SYNCH AUDIO-VIDEO EST LOW 20
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 98005
|
| Hospital Charge Code |
9609800501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 98004
|
| Hospital Charge Code |
9609800401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 98004
|
| Hospital Charge Code |
9609800401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.69
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$33.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.76
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$21.60
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 98004
|
| Hospital Charge Code |
9609800401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
9609800301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.91 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna of VT Commercial |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.60
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.20
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
9609800301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$308.46 |
| Rate for Payer: Aetna of VT Commercial |
$293.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$170.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.05
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare VA CCN |
$124.80
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
9609800301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna of VT Commercial |
$296.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$138.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$252.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.04
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.40
|
| Rate for Payer: United Healthcare Commercial |
$296.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.40
|
| Rate for Payer: United Healthcare VA CCN |
$140.40
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
9609800101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$168.55 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.55
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$78.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: United Healthcare Commercial |
$132.60
|
| Rate for Payer: United Healthcare VA CCN |
$62.40
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
9609800101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
9609800101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
9609800201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$243.32 |
| Rate for Payer: Aetna of VT Commercial |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.32
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$126.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$178.50
|
| Rate for Payer: United Healthcare VA CCN |
$84.00
|
|
