|
US DUPLEX SCN EXTRACRANIAL LTD
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
9729388201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$468.23 |
| Rate for Payer: Aetna of VT Commercial |
$337.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$468.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$468.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.84
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$25.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.51
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.51
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| Rate for Payer: United Healthcare VA CCN |
$21.51
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
IP
|
$614.84
|
|
|
Service Code
|
CPT 93882 LT
|
| Hospital Charge Code |
92093882LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$455.04 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$516.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.87
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
IP
|
$614.84
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9209388201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$455.04 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$516.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.87
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
OP
|
$614.84
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
92093882RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$272.31 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$498.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$276.68
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare VA CCN |
$276.68
|
|
|
US DUPLEX SCN LOWER EXTREM BI
|
Facility
|
OP
|
$899.58
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
9209392501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$398.42 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$541.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$728.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$715.17
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.81
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare VA CCN |
$404.81
|
|
|
US DUPLEX SCN LOWER EXTREM BI
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 93925 26
|
| Hospital Charge Code |
9729392501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of VT Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$86.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$100.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
US DUPLEX SCN LOWER EXTREM BI
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT 93925 26
|
| Hospital Charge Code |
9729392501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$971.88 |
| Rate for Payer: Aetna of VT Commercial |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$971.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$971.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.81
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$41.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$100.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.59
|
| Rate for Payer: United Healthcare Commercial |
$53.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.59
|
| Rate for Payer: United Healthcare VA CCN |
$34.59
|
|
|
US DUPLEX SCN LOWER EXTREM BI
|
Facility
|
IP
|
$899.58
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
9209392501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$665.78 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.66
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
|
|
US DUPLEX SCN LOWER EXTREM BI
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 93925 26
|
| Hospital Charge Code |
9729392501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of VT Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.86
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$86.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$100.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.60
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.60
|
| Rate for Payer: United Healthcare VA CCN |
$48.60
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
9729392601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$347.85 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.00
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
IP
|
$772.14
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
92093926LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$571.46 |
| Max. Negotiated Rate |
$733.53 |
| Rate for Payer: Aetna of VT Commercial |
$733.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$571.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$571.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$617.71
|
| Rate for Payer: Cash Price |
$386.07
|
| Rate for Payer: Cigna Commercial |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.71
|
| Rate for Payer: Multiplan Commercial |
$718.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.32
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
OP
|
$772.14
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
92093926LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$341.98 |
| Max. Negotiated Rate |
$733.53 |
| Rate for Payer: Aetna of VT Commercial |
$733.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$691.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$691.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$464.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$625.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$347.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$613.85
|
| Rate for Payer: Cash Price |
$386.07
|
| Rate for Payer: Cigna Commercial |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$347.46
|
| Rate for Payer: Multiplan Commercial |
$718.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$347.46
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.46
|
| Rate for Payer: United Healthcare VA CCN |
$347.46
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
OP
|
$772.14
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
92093926RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$341.98 |
| Max. Negotiated Rate |
$733.53 |
| Rate for Payer: Aetna of VT Commercial |
$733.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$691.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$691.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$464.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$625.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$347.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$613.85
|
| Rate for Payer: Cash Price |
$386.07
|
| Rate for Payer: Cigna Commercial |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$347.46
|
| Rate for Payer: Multiplan Commercial |
$718.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$347.46
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.46
|
| Rate for Payer: United Healthcare VA CCN |
$347.46
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
9729392601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$208.16 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$380.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.65
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare VA CCN |
$211.50
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9209392601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
IP
|
$772.14
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
92093926RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$571.46 |
| Max. Negotiated Rate |
$733.53 |
| Rate for Payer: Aetna of VT Commercial |
$733.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$571.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$571.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$617.71
|
| Rate for Payer: Cash Price |
$386.07
|
| Rate for Payer: Cigna Commercial |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.71
|
| Rate for Payer: Multiplan Commercial |
$718.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.32
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
9729392601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$498.74 |
| Rate for Payer: Aetna of VT Commercial |
$441.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$25.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.02
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$32.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.02
|
| Rate for Payer: United Healthcare VA CCN |
$21.02
|
|
|
US DUPLEX SCN LOWER EXTREM UNI
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9209392601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
US DUPLEX SCN UPPER EXTREM BI
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
9729393001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$752.19 |
| Rate for Payer: Aetna of VT Commercial |
$104.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.82
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$41.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.08
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.08
|
| Rate for Payer: United Healthcare Commercial |
$53.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.08
|
| Rate for Payer: United Healthcare VA CCN |
$35.08
|
|
|
US DUPLEX SCN UPPER EXTREM BI
|
Facility
|
OP
|
$895.70
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
9209393001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$396.71 |
| Max. Negotiated Rate |
$850.91 |
| Rate for Payer: Aetna of VT Commercial |
$850.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$802.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$396.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$802.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$539.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$725.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$403.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$712.08
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cigna Commercial |
$716.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$403.06
|
| Rate for Payer: Multiplan Commercial |
$833.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$761.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$403.06
|
| Rate for Payer: United Healthcare Commercial |
$850.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$403.06
|
| Rate for Payer: United Healthcare VA CCN |
$403.06
|
|
|
US DUPLEX SCN UPPER EXTREM BI
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
9729393001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$82.15 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of VT Commercial |
$105.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.80
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
|
|
US DUPLEX SCN UPPER EXTREM BI
|
Facility
|
IP
|
$895.70
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
9209393001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$662.91 |
| Max. Negotiated Rate |
$850.91 |
| Rate for Payer: Aetna of VT Commercial |
$850.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$662.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$662.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$761.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$752.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$716.56
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cigna Commercial |
$716.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$716.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$716.56
|
| Rate for Payer: Multiplan Commercial |
$833.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$761.35
|
| Rate for Payer: United Healthcare Commercial |
$850.91
|
|
|
US DUPLEX SCN UPPER EXTREM BI
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
9729393001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna of VT Commercial |
$105.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.25
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.95
|
| Rate for Payer: Multiplan Commercial |
$103.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$105.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.95
|
| Rate for Payer: United Healthcare VA CCN |
$49.95
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
9729393101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$171.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$233.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$308.46
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.60
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.60
|
| Rate for Payer: United Healthcare VA CCN |
$174.60
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
IP
|
$768.26
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
92093931LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$568.59 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Aetna of VT Commercial |
$729.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$653.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$645.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.61
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Cigna Commercial |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$614.61
|
| Rate for Payer: Multiplan Commercial |
$714.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$653.02
|
| Rate for Payer: United Healthcare Commercial |
$729.85
|
|
