|
TTE W/DOPPLER COMPLETE
|
Professional
|
Both
|
$3,141.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$2,952.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,952.54
|
| 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 |
$191.45
|
| 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 |
$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 |
$1,570.50
|
| Rate for Payer: Cash Price |
$1,570.50
|
| 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 |
$2,921.13
|
| 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
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5109330601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$2,271.98 |
| Rate for Payer: Aetna of VT Commercial |
$2,271.98
|
| 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 |
$191.45
|
| 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 |
$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 |
$1,208.50
|
| Rate for Payer: Cash Price |
$1,208.50
|
| 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 |
$2,247.81
|
| 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
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$535.83 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna of VT Commercial |
$687.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$608.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.20
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.20
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.40
|
| Rate for Payer: United Healthcare Commercial |
$687.80
|
|
|
TTE W/DOPPLER COMPLETE
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
9609330602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.66 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna of VT Commercial |
$687.80
|
| 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 |
$320.66
|
| 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 |
$435.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$586.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$575.58
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.80
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.80
|
| Rate for Payer: United Healthcare Commercial |
$687.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.80
|
| Rate for Payer: United Healthcare VA CCN |
$325.80
|
|
|
TTE W OR W/O CONTR, CONT ECG
|
Facility
|
OP
|
$2,593.27
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
480C893001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$2,463.61 |
| Rate for Payer: Aetna of VT Commercial |
$2,463.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,323.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,148.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,323.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,561.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,204.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,100.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,166.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,061.65
|
| Rate for Payer: Cash Price |
$1,296.63
|
| Rate for Payer: Cigna Commercial |
$2,074.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,074.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,074.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,166.97
|
| Rate for Payer: Multiplan Commercial |
$2,411.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,204.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,166.97
|
| Rate for Payer: United Healthcare Commercial |
$2,463.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.97
|
| Rate for Payer: United Healthcare VA CCN |
$1,166.97
|
|
|
TTE W OR W/O CONTR, CONT ECG
|
Facility
|
IP
|
$2,593.27
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
480C893001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,919.28 |
| Max. Negotiated Rate |
$2,463.61 |
| Rate for Payer: Aetna of VT Commercial |
$2,463.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,919.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,919.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,204.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,178.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,074.62
|
| Rate for Payer: Cash Price |
$1,296.63
|
| Rate for Payer: Cigna Commercial |
$2,074.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,074.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,074.62
|
| Rate for Payer: Multiplan Commercial |
$2,411.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,204.28
|
| Rate for Payer: United Healthcare Commercial |
$2,463.61
|
|
|
TTE W OR WO FOL WCON,DOPPLER
|
Facility
|
OP
|
$2,343.04
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
480C892901
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,037.73 |
| Max. Negotiated Rate |
$2,225.89 |
| Rate for Payer: Aetna of VT Commercial |
$2,225.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,099.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,037.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,099.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,410.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,991.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,897.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,054.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,862.72
|
| Rate for Payer: Cash Price |
$1,171.52
|
| Rate for Payer: Cigna Commercial |
$1,874.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,874.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,874.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,054.37
|
| Rate for Payer: Multiplan Commercial |
$2,179.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,991.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,054.37
|
| Rate for Payer: United Healthcare Commercial |
$2,225.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,054.37
|
| Rate for Payer: United Healthcare VA CCN |
$1,054.37
|
|
|
TTE W OR WO FOL WCON,DOPPLER
|
Facility
|
IP
|
$2,343.04
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
480C892901
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,734.08 |
| Max. Negotiated Rate |
$2,225.89 |
| Rate for Payer: Aetna of VT Commercial |
$2,225.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,734.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,734.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,991.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,968.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,874.43
|
| Rate for Payer: Cash Price |
$1,171.52
|
| Rate for Payer: Cigna Commercial |
$1,874.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,874.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,874.43
|
| Rate for Payer: Multiplan Commercial |
$2,179.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,991.58
|
| Rate for Payer: United Healthcare Commercial |
$2,225.89
|
|
|
TTE W OR W/O FOL W/CON,STRES
|
Facility
|
IP
|
$2,791.80
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
480C892801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,066.21 |
| Max. Negotiated Rate |
$2,652.21 |
| Rate for Payer: Aetna of VT Commercial |
$2,652.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,066.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,066.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,373.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,345.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,233.44
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$2,233.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,233.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,233.44
|
| Rate for Payer: Multiplan Commercial |
$2,596.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,373.03
|
| Rate for Payer: United Healthcare Commercial |
$2,652.21
|
|
|
TTE W OR W/O FOL W/CON,STRES
|
Facility
|
OP
|
$2,791.80
|
|
|
Service Code
|
CPT C8928
|
| Hospital Charge Code |
480C892801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,236.49 |
| Max. Negotiated Rate |
$2,652.21 |
| Rate for Payer: Aetna of VT Commercial |
$2,652.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,501.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,236.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,501.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,680.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,373.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,261.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,256.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,219.48
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$2,233.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,233.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,233.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,256.31
|
| Rate for Payer: Multiplan Commercial |
$2,596.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,373.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,256.31
|
| Rate for Payer: United Healthcare Commercial |
$2,652.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,256.31
|
| Rate for Payer: United Healthcare VA CCN |
$1,256.31
|
|
|
TUBERCULIN SKIN TEST
|
Facility
|
IP
|
$411.02
|
|
|
Service Code
|
NDC 4202310401
|
| Hospital Charge Code |
2500000296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$304.20 |
| Max. Negotiated Rate |
$390.47 |
| Rate for Payer: Aetna of VT Commercial |
$390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.82
|
| Rate for Payer: Cash Price |
$205.51
|
| Rate for Payer: Cigna Commercial |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.82
|
| Rate for Payer: Multiplan Commercial |
$382.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.37
|
| Rate for Payer: United Healthcare Commercial |
$390.47
|
|
|
TUBERCULIN SKIN TEST
|
Facility
|
OP
|
$411.02
|
|
| Hospital Charge Code |
2500000296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$390.47 |
| Rate for Payer: Aetna of VT Commercial |
$390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.76
|
| Rate for Payer: Cash Price |
$205.51
|
| Rate for Payer: Cigna Commercial |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.96
|
| Rate for Payer: Multiplan Commercial |
$382.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.96
|
| Rate for Payer: United Healthcare Commercial |
$390.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.96
|
| Rate for Payer: United Healthcare VA CCN |
$184.96
|
|
|
TUBERCULIN SKIN TEST
|
Facility
|
IP
|
$411.02
|
|
| Hospital Charge Code |
2500000296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$304.20 |
| Max. Negotiated Rate |
$390.47 |
| Rate for Payer: Aetna of VT Commercial |
$390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.82
|
| Rate for Payer: Cash Price |
$205.51
|
| Rate for Payer: Cigna Commercial |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.82
|
| Rate for Payer: Multiplan Commercial |
$382.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.37
|
| Rate for Payer: United Healthcare Commercial |
$390.47
|
|
|
TUBERCULIN SKIN TEST
|
Facility
|
OP
|
$411.02
|
|
|
Service Code
|
NDC 4202310401
|
| Hospital Charge Code |
2500000296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$390.47 |
| Rate for Payer: Aetna of VT Commercial |
$390.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.76
|
| Rate for Payer: Cash Price |
$205.51
|
| Rate for Payer: Cigna Commercial |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.96
|
| Rate for Payer: Multiplan Commercial |
$382.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.96
|
| Rate for Payer: United Healthcare Commercial |
$390.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.96
|
| Rate for Payer: United Healthcare VA CCN |
$184.96
|
|
|
TUB FEED DOBBHOFF 12F 43
|
Facility
|
OP
|
$11.77
|
|
| Hospital Charge Code |
2720052681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna of VT Commercial |
$11.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.36
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cigna Commercial |
$9.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare VA CCN |
$5.30
|
|
|
TUB FEED DOBBHOFF 12F 43
|
Facility
|
IP
|
$11.77
|
|
| Hospital Charge Code |
2720052681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna of VT Commercial |
$11.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.42
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cigna Commercial |
$9.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
|
|
TUB FEED DOBBHOFF 8F 43
|
Facility
|
IP
|
$10.86
|
|
| Hospital Charge Code |
2720052671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna of VT Commercial |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.69
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna Commercial |
$8.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.69
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$10.32
|
|
|
TUB FEED DOBBHOFF 8F 43
|
Facility
|
OP
|
$10.86
|
|
| Hospital Charge Code |
2720052671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna of VT Commercial |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.63
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cigna Commercial |
$8.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$10.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.89
|
| Rate for Payer: United Healthcare VA CCN |
$4.89
|
|
|
TUB FEEDING 8F S
|
Facility
|
IP
|
$1.57
|
|
| Hospital Charge Code |
2720019391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of VT Commercial |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.26
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
|
|
TUB FEEDING 8F S
|
Facility
|
OP
|
$1.57
|
|
| Hospital Charge Code |
2720019391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of VT Commercial |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.25
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$1.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.71
|
| Rate for Payer: United Healthcare VA CCN |
$0.71
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
OP
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$415.51 |
| Rate for Payer: Aetna of VT Commercial |
$415.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.72
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna Commercial |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.82
|
| Rate for Payer: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.82
|
| Rate for Payer: United Healthcare Commercial |
$415.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare VA CCN |
$196.82
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Professional
|
Both
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$411.14 |
| Rate for Payer: Aetna of VT Commercial |
$411.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.93
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna Commercial |
$154.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.56
|
| Rate for Payer: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare Commercial |
$176.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.55
|
| Rate for Payer: United Healthcare VA CCN |
$114.55
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
IP
|
$437.38
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
3008836001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$415.51 |
| Rate for Payer: Aetna of VT Commercial |
$415.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.90
|
| Rate for Payer: Cash Price |
$218.69
|
| Rate for Payer: Cigna Commercial |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.90
|
| Rate for Payer: Multiplan Commercial |
$406.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.77
|
| Rate for Payer: United Healthcare Commercial |
$415.51
|
|
|
TWIST DRILL 1.4MM DIA. AO
|
Facility
|
OP
|
$264.96
|
|
| Hospital Charge Code |
2720073271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$251.71 |
| Rate for Payer: Aetna of VT Commercial |
$251.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$237.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$237.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$159.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$225.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.64
|
| Rate for Payer: Cash Price |
$132.48
|
| Rate for Payer: Cigna Commercial |
$211.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.23
|
| Rate for Payer: Multiplan Commercial |
$246.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.23
|
| Rate for Payer: United Healthcare Commercial |
$251.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.23
|
| Rate for Payer: United Healthcare VA CCN |
$119.23
|
|
|
TWIST DRILL 1.4MM DIA. AO
|
Facility
|
IP
|
$264.96
|
|
| Hospital Charge Code |
2720073271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.10 |
| Max. Negotiated Rate |
$251.71 |
| Rate for Payer: Aetna of VT Commercial |
$251.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$196.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$196.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$225.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$211.97
|
| Rate for Payer: Cash Price |
$132.48
|
| Rate for Payer: Cigna Commercial |
$211.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.97
|
| Rate for Payer: Multiplan Commercial |
$246.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.22
|
| Rate for Payer: United Healthcare Commercial |
$251.71
|
|
