|
FITTING OF DIAPHRAGM/CAP
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
5105717001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of VT Commercial |
$172.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$163.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$163.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.69
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$169.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$172.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.90
|
| Rate for Payer: United Healthcare VA CCN |
$81.90
|
|
|
FIXATION OF KNEE JOINT
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
9822757001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$584.68 |
| Rate for Payer: Aetna of VT Commercial |
$584.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$557.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$557.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$206.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$242.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.61
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$278.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.78
|
| Rate for Payer: Multiplan Commercial |
$578.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.78
|
| Rate for Payer: United Healthcare Commercial |
$227.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.78
|
| Rate for Payer: United Healthcare VA CCN |
$147.78
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
9822757001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$275.48 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Aetna of VT Commercial |
$590.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$557.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$275.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$557.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$374.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$279.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$494.49
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$497.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$497.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$497.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$279.90
|
| Rate for Payer: Multiplan Commercial |
$578.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.90
|
| Rate for Payer: United Healthcare Commercial |
$590.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.90
|
| Rate for Payer: United Healthcare VA CCN |
$279.90
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
9822757001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$460.34 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Aetna of VT Commercial |
$590.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$460.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$460.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$497.60
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$497.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$497.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$497.60
|
| Rate for Payer: Multiplan Commercial |
$578.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.70
|
| Rate for Payer: United Healthcare Commercial |
$590.90
|
|
|
FLAT PE HC LINER 040/F
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.67 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$915.20
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
|
|
FLAT PE HC LINER 040/F
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.68 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$506.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$688.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$926.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$909.48
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$514.80
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare VA CCN |
$514.80
|
|
|
FLAT PE HC LINER 0 40/G
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.67 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$915.20
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
|
|
FLAT PE HC LINER 0 40/G
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.68 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$506.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$688.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$926.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$909.48
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$514.80
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare VA CCN |
$514.80
|
|
|
FL CMPL ACUTE ABDOMEN SERIES
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 74022 26
|
| Hospital Charge Code |
9727402201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Aetna of VT Commercial |
$120.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.97
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.15
|
| Rate for Payer: United Healthcare VA CCN |
$57.15
|
|
|
FL CMPL ACUTE ABDOMEN SERIES
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 74022 26
|
| Hospital Charge Code |
9727402201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Aetna of VT Commercial |
$120.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.60
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.60
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$120.65
|
|
|
FL CMPL ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
CPT 74022 26
|
| Hospital Charge Code |
9727402201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$151.54 |
| Rate for Payer: Aetna of VT Commercial |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.87
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.54
|
| Rate for Payer: Multiplan Commercial |
$118.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.54
|
| Rate for Payer: United Healthcare Commercial |
$22.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.54
|
| Rate for Payer: United Healthcare VA CCN |
$14.54
|
|
|
FL CMPL ACUTE ABDOMEN SERIES
|
Facility
|
OP
|
$750.68
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.54 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Aetna of VT Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$638.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$608.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$596.79
|
| Rate for Payer: Cash Price |
$375.34
|
| Rate for Payer: Cash Price |
$375.34
|
| Rate for Payer: Cigna Commercial |
$600.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$337.81
|
| Rate for Payer: Multiplan Commercial |
$698.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$337.81
|
| Rate for Payer: United Healthcare Commercial |
$713.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$337.81
|
| Rate for Payer: United Healthcare VA CCN |
$337.81
|
|
|
FL CMPL ACUTE ABDOMEN SERIES
|
Facility
|
IP
|
$750.68
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$555.58 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Aetna of VT Commercial |
$713.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$555.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$555.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$638.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.54
|
| Rate for Payer: Cash Price |
$375.34
|
| Rate for Payer: Cigna Commercial |
$600.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.54
|
| Rate for Payer: Multiplan Commercial |
$698.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.08
|
| Rate for Payer: United Healthcare Commercial |
$713.15
|
|
|
FL COLON DOUBLE CONTRAST STUDY
|
Facility
|
IP
|
$1,589.57
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
3207428001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,176.44 |
| Max. Negotiated Rate |
$1,510.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,510.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,176.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,176.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,335.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,271.66
|
| Rate for Payer: Cash Price |
$794.78
|
| Rate for Payer: Cigna Commercial |
$1,271.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,271.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,271.66
|
| Rate for Payer: Multiplan Commercial |
$1,478.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,351.13
|
| Rate for Payer: United Healthcare Commercial |
$1,510.09
|
|
|
FL COLON DOUBLE CONTRAST STUDY
|
Facility
|
OP
|
$1,589.57
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
3207428001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$696.03 |
| Max. Negotiated Rate |
$1,510.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,510.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$696.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$704.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$696.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$956.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,287.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$715.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,263.71
|
| Rate for Payer: Cash Price |
$794.78
|
| Rate for Payer: Cash Price |
$794.78
|
| Rate for Payer: Cigna Commercial |
$1,271.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,271.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,271.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$715.31
|
| Rate for Payer: Multiplan Commercial |
$1,478.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,351.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$715.31
|
| Rate for Payer: United Healthcare Commercial |
$1,510.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$715.31
|
| Rate for Payer: United Healthcare VA CCN |
$715.31
|
|
|
FL COLON DOUBLE CONTRAST STUDY
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 74280 26
|
| Hospital Charge Code |
9727428001
|
|
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
|
|
|
FL COLON DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 74280 26
|
| Hospital Charge Code |
9727428001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$696.03 |
| Rate for Payer: Aetna of VT Commercial |
$364.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$696.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$696.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.66
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.21
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.22
|
| Rate for Payer: United Healthcare Commercial |
$86.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.22
|
| Rate for Payer: United Healthcare VA CCN |
$56.22
|
|
|
FL COLON DOUBLE CONTRAST STUDY
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 74280 26
|
| Hospital Charge Code |
9727428001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$287.16 |
| 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 |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.40
|
| 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: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
|
|
FL COLON SINGLE CONTRAST STUDY
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 74270 26
|
| Hospital Charge Code |
9727427001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.40
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
|
|
FL COLON SINGLE CONTRAST STUDY
|
Facility
|
IP
|
$1,419.68
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
3207427001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,050.71 |
| Max. Negotiated Rate |
$1,348.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,348.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,050.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,050.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,206.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,192.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,135.74
|
| Rate for Payer: Cash Price |
$709.84
|
| Rate for Payer: Cigna Commercial |
$1,135.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.74
|
| Rate for Payer: Multiplan Commercial |
$1,320.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,206.73
|
| Rate for Payer: United Healthcare Commercial |
$1,348.70
|
|
|
FL COLON SINGLE CONTRAST STUDY
|
Facility
|
OP
|
$1,419.68
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
3207427001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$454.96 |
| Max. Negotiated Rate |
$1,348.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,348.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$628.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$854.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,206.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,149.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$638.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,128.65
|
| Rate for Payer: Cash Price |
$709.84
|
| Rate for Payer: Cash Price |
$709.84
|
| Rate for Payer: Cigna Commercial |
$1,135.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,135.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,135.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$638.86
|
| Rate for Payer: Multiplan Commercial |
$1,320.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,206.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$638.86
|
| Rate for Payer: United Healthcare Commercial |
$1,348.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$638.86
|
| Rate for Payer: United Healthcare VA CCN |
$638.86
|
|
|
FL COLON SINGLE CONTRAST STUDY
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 74270 26
|
| Hospital Charge Code |
9727427001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.79
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.35
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare VA CCN |
$145.35
|
|
|
FL COLON SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 74270 26
|
| Hospital Charge Code |
9727427001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$454.96 |
| Rate for Payer: Aetna of VT Commercial |
$303.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$454.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.07
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$69.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.19
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$71.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.20
|
| Rate for Payer: United Healthcare VA CCN |
$46.20
|
|
|
FLEXIGRAFT GRAFTLINK 9.5X70MM
|
Facility
|
IP
|
$2,468.72
|
|
| Hospital Charge Code |
2780072071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.10 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,345.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,827.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,827.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,098.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,073.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,974.98
|
| Rate for Payer: Cash Price |
$1,234.36
|
| Rate for Payer: Cigna Commercial |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,974.98
|
| Rate for Payer: Multiplan Commercial |
$2,295.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,098.41
|
| Rate for Payer: United Healthcare Commercial |
$2,345.28
|
|
|
FLEXIGRAFT GRAFTLINK 9.5X70MM
|
Facility
|
OP
|
$2,468.72
|
|
| Hospital Charge Code |
2780072071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.40 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna of VT Commercial |
$2,345.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,211.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,093.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,211.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,486.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,098.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,999.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,110.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,962.63
|
| Rate for Payer: Cash Price |
$1,234.36
|
| Rate for Payer: Cigna Commercial |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,974.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,974.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,110.92
|
| Rate for Payer: Multiplan Commercial |
$2,295.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,098.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,110.92
|
| Rate for Payer: United Healthcare Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,110.92
|
| Rate for Payer: United Healthcare VA CCN |
$1,110.92
|
|
