|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna of VT Commercial |
$50.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.13
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$42.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.85
|
| Rate for Payer: Multiplan Commercial |
$49.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.85
|
| Rate for Payer: United Healthcare Commercial |
$50.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.85
|
| Rate for Payer: United Healthcare VA CCN |
$23.85
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of VT Commercial |
$997.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$465.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$632.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$850.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$472.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$834.75
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$840.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$472.50
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$892.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$997.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.50
|
| Rate for Payer: United Healthcare VA CCN |
$472.50
|
|
|
TTE F-UP OR LMTD
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$360.02 |
| Rate for Payer: Aetna of VT Commercial |
$360.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.67
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$218.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.29
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare VA CCN |
$93.30
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.49
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.35
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare VA CCN |
$172.35
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$421.68
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
4809330801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$186.76 |
| Max. Negotiated Rate |
$400.60 |
| Rate for Payer: Aetna of VT Commercial |
$400.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$377.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$377.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$253.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$335.24
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cigna Commercial |
$337.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.76
|
| Rate for Payer: Multiplan Commercial |
$392.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$358.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.76
|
| Rate for Payer: United Healthcare Commercial |
$400.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.76
|
| Rate for Payer: United Healthcare VA CCN |
$189.76
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$666.93
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
4509330801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.38 |
| Max. Negotiated Rate |
$633.58 |
| Rate for Payer: Aetna of VT Commercial |
$633.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$597.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$295.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$597.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$401.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$540.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$300.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.21
|
| Rate for Payer: Cash Price |
$333.46
|
| Rate for Payer: Cigna Commercial |
$533.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$533.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$533.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.12
|
| Rate for Payer: Multiplan Commercial |
$620.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$300.12
|
| Rate for Payer: United Healthcare Commercial |
$633.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.12
|
| Rate for Payer: United Healthcare VA CCN |
$300.12
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna of VT Commercial |
$50.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.40
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$42.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$49.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.05
|
| Rate for Payer: United Healthcare Commercial |
$50.35
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$666.93
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
4509330801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$633.58 |
| Rate for Payer: Aetna of VT Commercial |
$633.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$560.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$533.54
|
| Rate for Payer: Cash Price |
$333.46
|
| Rate for Payer: Cigna Commercial |
$533.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$533.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$533.54
|
| Rate for Payer: Multiplan Commercial |
$620.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.89
|
| Rate for Payer: United Healthcare Commercial |
$633.58
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$283.46 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$306.40
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5109330801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Aetna of VT Commercial |
$633.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$597.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$295.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$597.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$401.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$540.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$300.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$530.26
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$533.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$533.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.15
|
| Rate for Payer: Multiplan Commercial |
$620.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$300.15
|
| Rate for Payer: United Healthcare Commercial |
$633.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.15
|
| Rate for Payer: United Healthcare VA CCN |
$300.15
|
|
|
TTE F-UP OR LMTD
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$218.80 |
| Rate for Payer: Aetna of VT Commercial |
$49.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.67
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$218.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.29
|
| Rate for Payer: Multiplan Commercial |
$49.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare VA CCN |
$93.30
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$777.11 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: Aetna of VT Commercial |
$997.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$777.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$777.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$840.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$840.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$997.50
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$421.68
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
4809330801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$312.09 |
| Max. Negotiated Rate |
$400.60 |
| Rate for Payer: Aetna of VT Commercial |
$400.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$312.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.34
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cigna Commercial |
$337.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.34
|
| Rate for Payer: Multiplan Commercial |
$392.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$358.43
|
| Rate for Payer: United Healthcare Commercial |
$400.60
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5109330801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$493.65 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Aetna of VT Commercial |
$633.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$493.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$493.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$560.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$533.60
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$533.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$620.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.95
|
| Rate for Payer: United Healthcare Commercial |
$633.65
|
|
|
TTE F-UP OR LMTD
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$283.46 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$306.40
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
|
|
TTE F-UP OR LMTD
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5109330801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$626.98 |
| Rate for Payer: Aetna of VT Commercial |
$626.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$597.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$597.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.67
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$218.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.29
|
| Rate for Payer: Multiplan Commercial |
$620.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare VA CCN |
$93.30
|
|
|
TTE F-UP OR LMTD
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9609330801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Aetna of VT Commercial |
$987.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$940.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.67
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$218.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.29
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare VA CCN |
$93.30
|
|
|
TTE F-UP OR LMTD
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.49
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.35
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare VA CCN |
$172.35
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
IP
|
$3,141.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,324.65 |
| Max. Negotiated Rate |
$2,983.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,983.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,324.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,324.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,669.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,638.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,512.80
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$2,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,512.80
|
| Rate for Payer: Multiplan Commercial |
$2,921.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,669.85
|
| Rate for Payer: United Healthcare Commercial |
$2,983.95
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
IP
|
$1,078.26
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
4809330601
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$798.02 |
| Max. Negotiated Rate |
$1,024.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,024.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$798.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$798.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$916.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$905.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$862.61
|
| Rate for Payer: Cash Price |
$539.13
|
| Rate for Payer: Cigna Commercial |
$862.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$862.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$862.61
|
| Rate for Payer: Multiplan Commercial |
$1,002.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$916.52
|
| Rate for Payer: United Healthcare Commercial |
$1,024.35
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5109330601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,788.82 |
| Max. Negotiated Rate |
$2,296.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,296.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,788.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,788.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,054.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,030.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,208.50
|
| Rate for Payer: Cigna Commercial |
$1,933.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,933.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,933.60
|
| Rate for Payer: Multiplan Commercial |
$2,247.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,054.45
|
| Rate for Payer: United Healthcare Commercial |
$2,296.15
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
OP
|
$1,078.26
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
4809330601
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$477.56 |
| Max. Negotiated Rate |
$1,024.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,024.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$966.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$477.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$966.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$649.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$916.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$873.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$485.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$857.22
|
| Rate for Payer: Cash Price |
$539.13
|
| Rate for Payer: Cigna Commercial |
$862.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$862.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$862.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$485.22
|
| Rate for Payer: Multiplan Commercial |
$1,002.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$916.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$485.22
|
| Rate for Payer: United Healthcare Commercial |
$1,024.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$485.22
|
| Rate for Payer: United Healthcare VA CCN |
$485.22
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
OP
|
$3,141.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,391.15 |
| Max. Negotiated Rate |
$2,983.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,983.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,814.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,391.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,814.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,890.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,669.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,544.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,413.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,497.09
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$2,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,512.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,512.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,413.45
|
| Rate for Payer: Multiplan Commercial |
$2,921.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,669.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,413.45
|
| Rate for Payer: United Healthcare Commercial |
$2,983.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,413.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,413.45
|
|
|
TTE W/DOPPLER COMPLETE
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$680.56 |
| Rate for Payer: Aetna of VT Commercial |
$680.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.08
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$435.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$298.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$298.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.87
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.87
|
| Rate for Payer: United Healthcare Commercial |
$285.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.87
|
| Rate for Payer: United Healthcare VA CCN |
$185.87
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5109330601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,070.49 |
| Max. Negotiated Rate |
$2,296.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,296.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,165.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,070.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,165.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,455.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,054.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,957.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,087.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,921.52
|
| Rate for Payer: Cash Price |
$1,208.50
|
| Rate for Payer: Cigna Commercial |
$1,933.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,933.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,933.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,087.65
|
| Rate for Payer: Multiplan Commercial |
$2,247.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,054.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,087.65
|
| Rate for Payer: United Healthcare Commercial |
$2,296.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.65
|
| Rate for Payer: United Healthcare VA CCN |
$1,087.65
|
|
