|
EVOKED AUDITORY TEST QUAL
|
Professional
|
Both
|
$90.99
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
4719255801
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$85.53 |
| Rate for Payer: Aetna of VT Commercial |
$85.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.10
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$9.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.71
|
| Rate for Payer: Multiplan Commercial |
$84.62
|
| Rate for Payer: United Healthcare Commercial |
$77.34
|
| Rate for Payer: United Healthcare VA CCN |
$8.60
|
|
|
EVOKED AUDITORY TEST QUAL
|
Facility
|
OP
|
$90.99
|
|
|
Service Code
|
CPT 92558
|
| Hospital Charge Code |
4719255801
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$86.44 |
| Rate for Payer: Aetna of VT Commercial |
$86.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.34
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.95
|
| Rate for Payer: Multiplan Commercial |
$84.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare Commercial |
$86.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.95
|
| Rate for Payer: United Healthcare VA CCN |
$40.95
|
|
|
EXAM OF CERVIX W/SCOPE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
5105745201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.66 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.36
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$148.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.71
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare Commercial |
$130.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare VA CCN |
$84.66
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna of VT Commercial |
$380.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$177.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$241.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$340.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$324.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$180.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.80
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$320.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$180.45
|
| Rate for Payer: Multiplan Commercial |
$372.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$180.45
|
| Rate for Payer: United Healthcare Commercial |
$380.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.45
|
| Rate for Payer: United Healthcare VA CCN |
$180.45
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
5105745201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
EXAM OF CERVIX W/SCOPE
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.66 |
| Max. Negotiated Rate |
$376.94 |
| Rate for Payer: Aetna of VT Commercial |
$376.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.36
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$148.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.71
|
| Rate for Payer: Multiplan Commercial |
$372.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare Commercial |
$130.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare VA CCN |
$84.66
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
5105745201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna of VT Commercial |
$255.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.85
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.05
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.05
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.05
|
| Rate for Payer: United Healthcare VA CCN |
$121.05
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna of VT Commercial |
$255.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.20
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.20
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.65
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$296.78 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna of VT Commercial |
$380.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$296.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$296.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$340.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$336.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$320.80
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$320.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$320.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$320.80
|
| Rate for Payer: Multiplan Commercial |
$372.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$340.85
|
| Rate for Payer: United Healthcare Commercial |
$380.95
|
|
|
EXAM OF CERVIX W/SCOPE
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
9605745202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.66 |
| Max. Negotiated Rate |
$252.86 |
| Rate for Payer: Aetna of VT Commercial |
$252.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.36
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$148.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$195.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$195.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.71
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare Commercial |
$130.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.66
|
| Rate for Payer: United Healthcare VA CCN |
$84.66
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
9825742001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$261.26 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna of VT Commercial |
$335.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$296.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.40
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$282.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.40
|
| Rate for Payer: Multiplan Commercial |
$328.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.05
|
| Rate for Payer: United Healthcare Commercial |
$335.35
|
|
|
EXAM OF VAGINA W/SCOPE
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
9825742001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$331.82 |
| Rate for Payer: Aetna of VT Commercial |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$316.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$316.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.73
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.02
|
| Rate for Payer: Multiplan Commercial |
$328.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.26
|
| Rate for Payer: United Healthcare Commercial |
$128.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.26
|
| Rate for Payer: United Healthcare VA CCN |
$83.26
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
9825742001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$156.34 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna of VT Commercial |
$335.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$316.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$316.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$212.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.63
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$282.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.85
|
| Rate for Payer: Multiplan Commercial |
$328.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$158.85
|
| Rate for Payer: United Healthcare Commercial |
$335.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.85
|
| Rate for Payer: United Healthcare VA CCN |
$158.85
|
|
|
EXAM SYNOVIAL FLUID CRYSTALS
|
Facility
|
OP
|
$539.10
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$512.14 |
| Rate for Payer: Aetna of VT Commercial |
$512.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$436.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$242.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$428.58
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna Commercial |
$431.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$431.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$431.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$242.59
|
| Rate for Payer: Multiplan Commercial |
$501.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$458.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$242.59
|
| Rate for Payer: United Healthcare Commercial |
$512.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: United Healthcare VA CCN |
$242.59
|
|
|
EXAM SYNOVIAL FLUID CRYSTALS
|
Facility
|
IP
|
$539.10
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.99 |
| Max. Negotiated Rate |
$512.14 |
| Rate for Payer: Aetna of VT Commercial |
$512.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$458.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$431.28
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna Commercial |
$431.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$431.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$431.28
|
| Rate for Payer: Multiplan Commercial |
$501.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$458.24
|
| Rate for Payer: United Healthcare Commercial |
$512.14
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Professional
|
Both
|
$1,405.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
9822407601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$517.63 |
| Max. Negotiated Rate |
$1,320.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,320.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$533.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$724.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$759.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$759.88
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$979.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$864.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$864.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$1,306.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$735.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$517.63
|
| Rate for Payer: United Healthcare Commercial |
$796.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$517.63
|
| Rate for Payer: United Healthcare VA CCN |
$517.63
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
IP
|
$1,405.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
9822407601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,039.84 |
| Max. Negotiated Rate |
$1,334.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,039.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,039.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,194.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,180.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,124.00
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$1,124.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,124.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,124.00
|
| Rate for Payer: Multiplan Commercial |
$1,306.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,194.25
|
| Rate for Payer: United Healthcare Commercial |
$1,334.75
|
|
|
EX ARM/ELBOW TUM DEEP < 5 CM
|
Facility
|
OP
|
$1,405.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
9822407601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$622.27 |
| Max. Negotiated Rate |
$1,334.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$622.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,258.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$845.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,194.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,138.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$632.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,116.97
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$1,124.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,124.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,124.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$632.25
|
| Rate for Payer: Multiplan Commercial |
$1,306.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,194.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$632.25
|
| Rate for Payer: United Healthcare Commercial |
$1,334.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$632.25
|
| Rate for Payer: United Healthcare VA CCN |
$632.25
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
OP
|
$4,507.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
5102407301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,996.15 |
| Max. Negotiated Rate |
$4,281.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,281.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,037.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,996.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,037.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,713.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,830.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,650.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,028.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,583.07
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,605.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,028.15
|
| Rate for Payer: Multiplan Commercial |
$4,191.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,830.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,028.15
|
| Rate for Payer: United Healthcare Commercial |
$4,281.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,028.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,028.15
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
OP
|
$6,453.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
9602407301
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,858.03 |
| Max. Negotiated Rate |
$6,130.35 |
| Rate for Payer: Aetna of VT Commercial |
$6,130.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,781.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,858.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,781.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,884.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,485.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,226.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,903.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,130.14
|
| Rate for Payer: Cash Price |
$3,226.50
|
| Rate for Payer: Cigna Commercial |
$5,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,162.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,162.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,903.85
|
| Rate for Payer: Multiplan Commercial |
$6,001.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,485.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,903.85
|
| Rate for Payer: United Healthcare Commercial |
$6,130.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,903.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,903.85
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
IP
|
$4,507.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
5102407301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,335.63 |
| Max. Negotiated Rate |
$4,281.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,281.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,335.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,335.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,830.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,785.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,605.60
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,605.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,605.60
|
| Rate for Payer: Multiplan Commercial |
$4,191.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,830.95
|
| Rate for Payer: United Healthcare Commercial |
$4,281.65
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
9822407301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$861.88 |
| Max. Negotiated Rate |
$1,848.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$861.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,743.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,171.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,654.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,576.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$875.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,547.07
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,556.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,654.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$875.70
|
| Rate for Payer: United Healthcare Commercial |
$1,848.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$875.70
|
| Rate for Payer: United Healthcare VA CCN |
$875.70
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
9822407301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,440.23 |
| Max. Negotiated Rate |
$1,848.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,440.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,440.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,654.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,634.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,556.80
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,556.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,556.80
|
| Rate for Payer: Multiplan Commercial |
$1,809.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare Commercial |
$1,848.70
|
|
|
EX ARM/ELBOW TUM DEEP 5 CM/>
|
Professional
|
Both
|
$4,507.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
5102407301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$648.18 |
| Max. Negotiated Rate |
$4,236.58 |
| Rate for Payer: Aetna of VT Commercial |
$4,236.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,037.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$667.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,037.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$907.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$818.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$818.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$745.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$818.81
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$1,226.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,089.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,089.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$648.18
|
| Rate for Payer: Multiplan Commercial |
$4,191.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$920.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$648.18
|
| Rate for Payer: United Healthcare Commercial |
$997.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.18
|
| Rate for Payer: United Healthcare VA CCN |
$648.18
|
|
