|
CARDIOVASCULAR STRESS TEST
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 93017 26
|
| Hospital Charge Code |
9729301701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna of VT Commercial |
$188.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.51
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$5.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.63
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$170.00
|
| Rate for Payer: United Healthcare VA CCN |
$80.00
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9859301801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
9859301601
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$79.19 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna of VT Commercial |
$101.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.60
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.95
|
| Rate for Payer: United Healthcare Commercial |
$101.65
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
9859301601
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna of VT Commercial |
$101.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.06
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.15
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.15
|
| Rate for Payer: United Healthcare Commercial |
$101.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.15
|
| Rate for Payer: United Healthcare VA CCN |
$48.15
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9859301801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
OP
|
$1,335.88
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$591.66 |
| Max. Negotiated Rate |
$1,269.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,269.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,196.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$591.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,196.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$804.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,135.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,082.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$601.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,062.02
|
| Rate for Payer: Cash Price |
$667.94
|
| Rate for Payer: Cigna Commercial |
$1,068.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,068.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,068.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$601.15
|
| Rate for Payer: Multiplan Commercial |
$1,242.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,135.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$601.15
|
| Rate for Payer: United Healthcare Commercial |
$1,269.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$601.15
|
| Rate for Payer: United Healthcare VA CCN |
$601.15
|
|
|
CARDIOVASCULAR STRESS TEST
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9859301801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.75
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$30.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare Commercial |
$20.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare VA CCN |
$13.40
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
IP
|
$1,335.88
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$988.68 |
| Max. Negotiated Rate |
$1,269.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,269.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$988.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$988.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,135.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,122.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,068.70
|
| Rate for Payer: Cash Price |
$667.94
|
| Rate for Payer: Cigna Commercial |
$1,068.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,068.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,068.70
|
| Rate for Payer: Multiplan Commercial |
$1,242.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,135.50
|
| Rate for Payer: United Healthcare Commercial |
$1,269.09
|
|
|
CARDIOVASCULAR STRESS TEST
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
9859301601
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$19.86 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna of VT Commercial |
$100.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.29
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$45.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$99.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.86
|
| Rate for Payer: United Healthcare Commercial |
$30.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.86
|
| Rate for Payer: United Healthcare VA CCN |
$19.86
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 93017 26
|
| Hospital Charge Code |
9729301701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$148.02 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of VT Commercial |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$160.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.00
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 93017 26
|
| Hospital Charge Code |
9729301701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna of VT Commercial |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$160.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare VA CCN |
$90.00
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
5109296001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,230.79 |
| Max. Negotiated Rate |
$1,579.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,579.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,230.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,230.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,413.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,396.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,330.40
|
| Rate for Payer: Cash Price |
$831.50
|
| Rate for Payer: Cigna Commercial |
$1,330.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,330.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,330.40
|
| Rate for Payer: Multiplan Commercial |
$1,546.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,413.55
|
| Rate for Payer: United Healthcare Commercial |
$1,579.85
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$1,662.67
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4509296001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$1,579.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,579.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,489.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$736.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,489.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,413.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,346.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$748.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,321.82
|
| Rate for Payer: Cash Price |
$831.34
|
| Rate for Payer: Cigna Commercial |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,330.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$748.20
|
| Rate for Payer: Multiplan Commercial |
$1,546.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,413.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$748.20
|
| Rate for Payer: United Healthcare Commercial |
$1,579.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$748.20
|
| Rate for Payer: United Healthcare VA CCN |
$748.20
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$2,267.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9609296001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,677.81 |
| Max. Negotiated Rate |
$2,153.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,153.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,677.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,677.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,926.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,904.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$1,813.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,813.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,813.60
|
| Rate for Payer: Multiplan Commercial |
$2,108.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,926.95
|
| Rate for Payer: United Healthcare Commercial |
$2,153.65
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
5109296001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$736.54 |
| Max. Negotiated Rate |
$1,579.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,579.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,489.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$736.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,489.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,001.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,413.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,347.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$748.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,322.09
|
| Rate for Payer: Cash Price |
$831.50
|
| Rate for Payer: Cigna Commercial |
$1,330.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,330.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,330.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$748.35
|
| Rate for Payer: Multiplan Commercial |
$1,546.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,413.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$748.35
|
| Rate for Payer: United Healthcare Commercial |
$1,579.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$748.35
|
| Rate for Payer: United Healthcare VA CCN |
$748.35
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9819296001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$166.97 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna of VT Commercial |
$358.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$337.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$337.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$320.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$305.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.71
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$301.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.65
|
| Rate for Payer: Multiplan Commercial |
$350.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.65
|
| Rate for Payer: United Healthcare Commercial |
$358.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.65
|
| Rate for Payer: United Healthcare VA CCN |
$169.65
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9819296001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$358.15 |
| Rate for Payer: Aetna of VT Commercial |
$358.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$320.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$316.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$301.60
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$301.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.60
|
| Rate for Payer: Multiplan Commercial |
$350.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$320.45
|
| Rate for Payer: United Healthcare Commercial |
$358.15
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9609296002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$567.76 |
| Rate for Payer: Aetna of VT Commercial |
$567.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.40
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$232.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.11
|
| Rate for Payer: Multiplan Commercial |
$561.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare Commercial |
$155.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare VA CCN |
$101.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9609296001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$2,130.98 |
| Rate for Payer: Aetna of VT Commercial |
$2,130.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,031.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,031.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.40
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cash Price |
$1,133.50
|
| Rate for Payer: Cigna Commercial |
$232.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.11
|
| Rate for Payer: Multiplan Commercial |
$2,108.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare Commercial |
$155.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare VA CCN |
$101.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9819296001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: Aetna of VT Commercial |
$354.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$337.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$337.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.40
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$232.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.11
|
| Rate for Payer: Multiplan Commercial |
$350.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare Commercial |
$155.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare VA CCN |
$101.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$1,662.67
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,230.54 |
| Max. Negotiated Rate |
$1,579.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,579.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,230.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,230.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,413.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,396.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,330.14
|
| Rate for Payer: Cash Price |
$831.34
|
| Rate for Payer: Cigna Commercial |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,330.14
|
| Rate for Payer: Multiplan Commercial |
$1,546.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,413.27
|
| Rate for Payer: United Healthcare Commercial |
$1,579.54
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9609296002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$447.02 |
| Max. Negotiated Rate |
$573.80 |
| Rate for Payer: Aetna of VT Commercial |
$573.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$447.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$447.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$513.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.20
|
| Rate for Payer: Cash Price |
$302.00
|
| Rate for Payer: Cigna Commercial |
$483.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$483.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$483.20
|
| Rate for Payer: Multiplan Commercial |
$561.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$513.40
|
| Rate for Payer: United Healthcare Commercial |
$573.80
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
5109296001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$1,563.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,563.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,489.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,489.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.40
|
| Rate for Payer: Cash Price |
$831.50
|
| Rate for Payer: Cash Price |
$831.50
|
| Rate for Payer: Cigna Commercial |
$232.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.11
|
| Rate for Payer: Multiplan Commercial |
$1,546.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare Commercial |
$155.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.10
|
| Rate for Payer: United Healthcare VA CCN |
$101.10
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$1,662.67
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
4809296001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$1,579.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,579.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,489.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$736.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,489.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,000.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,413.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,346.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$748.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,321.82
|
| Rate for Payer: Cash Price |
$831.34
|
| Rate for Payer: Cigna Commercial |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,330.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,330.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$748.20
|
| Rate for Payer: Multiplan Commercial |
$1,546.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,413.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$748.20
|
| Rate for Payer: United Healthcare Commercial |
$1,579.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$748.20
|
| Rate for Payer: United Healthcare VA CCN |
$748.20
|
|
|
CARDIOVERSION ELECTRIC EXT
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
9829296001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$307.82 |
| Max. Negotiated Rate |
$660.25 |
| Rate for Payer: Aetna of VT Commercial |
$660.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.52
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$556.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$556.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$646.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare Commercial |
$660.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.75
|
| Rate for Payer: United Healthcare VA CCN |
$312.75
|
|
