|
TWIST DRILL 1.9MM DIA. AO
|
Facility
|
OP
|
$264.96
|
|
| Hospital Charge Code |
2720037431
|
|
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 1.9MM DIA. AO
|
Facility
|
IP
|
$264.96
|
|
| Hospital Charge Code |
2720037431
|
|
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
|
|
|
TWIST DRILL 1.9MM DIA STRYKER
|
Facility
|
IP
|
$264.96
|
|
| Hospital Charge Code |
2720073281
|
|
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
|
|
|
TWIST DRILL 1.9MM DIA STRYKER
|
Facility
|
OP
|
$264.96
|
|
| Hospital Charge Code |
2720073281
|
|
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 2.5MM DIA. AO
|
Facility
|
IP
|
$264.96
|
|
| Hospital Charge Code |
2720037441
|
|
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
|
|
|
TWIST DRILL 2.5MM DIA. AO
|
Facility
|
OP
|
$264.96
|
|
| Hospital Charge Code |
2720037441
|
|
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
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
IP
|
$210.94
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
4509637501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.75
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
OP
|
$210.94
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.70
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.92
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.92
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.92
|
| Rate for Payer: United Healthcare VA CCN |
$94.92
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9819637502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
OP
|
$210.94
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
4509637501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.43 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$188.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$188.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.70
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.92
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.92
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.92
|
| Rate for Payer: United Healthcare VA CCN |
$94.92
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9819637502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna of VT Commercial |
$82.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.53
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$17.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$21.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.00
|
| Rate for Payer: United Healthcare VA CCN |
$14.00
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9819637502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.96
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare VA CCN |
$39.60
|
|
|
TX/PRO/DX INJ NEW DRUG ADDON
|
Facility
|
IP
|
$210.94
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.75
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
|
|
TX/PRO/DX INJ SAME DRUG ADON
|
Facility
|
IP
|
$246.09
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
4509637601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.13 |
| Max. Negotiated Rate |
$233.79 |
| Rate for Payer: Aetna of VT Commercial |
$233.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.87
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cigna Commercial |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.87
|
| Rate for Payer: Multiplan Commercial |
$228.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.18
|
| Rate for Payer: United Healthcare Commercial |
$233.79
|
|
|
TX/PRO/DX INJ SAME DRUG ADON
|
Facility
|
OP
|
$246.09
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
4509637601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.99 |
| Max. Negotiated Rate |
$233.79 |
| Rate for Payer: Aetna of VT Commercial |
$233.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.64
|
| Rate for Payer: Cash Price |
$123.04
|
| Rate for Payer: Cigna Commercial |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.74
|
| Rate for Payer: Multiplan Commercial |
$228.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.74
|
| Rate for Payer: United Healthcare Commercial |
$233.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.74
|
| Rate for Payer: United Healthcare VA CCN |
$110.74
|
|
|
TX/PROPH/DG ADDL SEQ IV INF
|
Facility
|
IP
|
$233.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
4509636701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of VT Commercial |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.94
|
| Rate for Payer: Cash Price |
$116.84
|
| Rate for Payer: Cigna Commercial |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.94
|
| Rate for Payer: Multiplan Commercial |
$217.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.63
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
TX/PROPH/DG ADDL SEQ IV INF
|
Facility
|
OP
|
$233.68
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
4509636701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna of VT Commercial |
$222.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.78
|
| Rate for Payer: Cash Price |
$116.84
|
| Rate for Payer: Cigna Commercial |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.16
|
| Rate for Payer: Multiplan Commercial |
$217.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.16
|
| Rate for Payer: United Healthcare VA CCN |
$105.16
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna of VT Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.60
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$37.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$43.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.95
|
| Rate for Payer: United Healthcare Commercial |
$44.65
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna of VT Commercial |
$114.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.80
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$96.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.80
|
| Rate for Payer: Multiplan Commercial |
$112.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.85
|
| Rate for Payer: United Healthcare Commercial |
$114.95
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
5109255001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of VT Commercial |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.97
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$23.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare VA CCN |
$20.80
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Professional
|
Both
|
$74.45
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
4719255001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$69.98 |
| Rate for Payer: Aetna of VT Commercial |
$69.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.97
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$23.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.80
|
| Rate for Payer: United Healthcare VA CCN |
$20.80
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
5109255001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.62
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare VA CCN |
$33.75
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
5109255001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
9609255002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna of VT Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.37
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$37.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$43.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$44.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.15
|
| Rate for Payer: United Healthcare VA CCN |
$21.15
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
4719255001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.56
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
|
