|
MM MAMMO DX INCL CAD BILAT
|
Facility
|
OP
|
$683.99
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
4017706601
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$649.79 |
| Rate for Payer: Aetna of VT Commercial |
$649.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$302.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$411.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$581.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$543.77
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$547.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$547.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$547.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$307.80
|
| Rate for Payer: Multiplan Commercial |
$636.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$581.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$307.80
|
| Rate for Payer: United Healthcare Commercial |
$649.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.80
|
| Rate for Payer: United Healthcare VA CCN |
$307.80
|
|
|
MM MAMMO DX INCL CAD BILAT
|
Facility
|
IP
|
$683.99
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
4017706601
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$506.22 |
| Max. Negotiated Rate |
$649.79 |
| Rate for Payer: Aetna of VT Commercial |
$649.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$506.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$506.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$581.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$574.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$547.19
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$547.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$547.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$547.19
|
| Rate for Payer: Multiplan Commercial |
$636.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$581.39
|
| Rate for Payer: United Healthcare Commercial |
$649.79
|
|
|
MM MAMMO DX INCL CAD BILAT
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 77066 26
|
| Hospital Charge Code |
9727706601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
MM MAMMO DX INCL CAD BILAT
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 77066 26
|
| Hospital Charge Code |
9727706601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
MM MAMMO DX INCL CAD BILAT
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 77066 26
|
| Hospital Charge Code |
9727706601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$485.09 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$485.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.30
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$67.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
IP
|
$570.25
|
|
|
Service Code
|
CPT 77065 LT
|
| Hospital Charge Code |
40177065LT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$541.74 |
| Rate for Payer: Aetna of VT Commercial |
$541.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$422.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$422.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$479.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.20
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cigna Commercial |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.20
|
| Rate for Payer: Multiplan Commercial |
$530.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.71
|
| Rate for Payer: United Healthcare Commercial |
$541.74
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 77065 26
|
| Hospital Charge Code |
9727706501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$193.10 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Aetna of VT Commercial |
$414.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$390.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$390.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$262.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$370.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$346.62
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$348.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$348.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$348.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.20
|
| Rate for Payer: Multiplan Commercial |
$405.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.20
|
| Rate for Payer: United Healthcare Commercial |
$414.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.20
|
| Rate for Payer: United Healthcare VA CCN |
$196.20
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
IP
|
$570.25
|
|
|
Service Code
|
CPT 77065 RT
|
| Hospital Charge Code |
40177065RT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$541.74 |
| Rate for Payer: Aetna of VT Commercial |
$541.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$422.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$422.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$479.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$456.20
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cigna Commercial |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.20
|
| Rate for Payer: Multiplan Commercial |
$530.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.71
|
| Rate for Payer: United Healthcare Commercial |
$541.74
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
OP
|
$570.25
|
|
|
Service Code
|
CPT 77065 LT
|
| Hospital Charge Code |
40177065LT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$541.74 |
| Rate for Payer: Aetna of VT Commercial |
$541.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$343.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$461.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$453.35
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cigna Commercial |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.61
|
| Rate for Payer: Multiplan Commercial |
$530.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.61
|
| Rate for Payer: United Healthcare Commercial |
$541.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.61
|
| Rate for Payer: United Healthcare VA CCN |
$256.61
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 77065 26
|
| Hospital Charge Code |
9727706501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$322.68 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Aetna of VT Commercial |
$414.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$322.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$322.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$370.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$366.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.80
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$348.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$348.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$348.80
|
| Rate for Payer: Multiplan Commercial |
$405.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$370.60
|
| Rate for Payer: United Healthcare Commercial |
$414.20
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Facility
|
OP
|
$570.25
|
|
|
Service Code
|
CPT 77065 RT
|
| Hospital Charge Code |
40177065RT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$541.74 |
| Rate for Payer: Aetna of VT Commercial |
$541.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$252.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$343.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$484.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$461.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$256.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$453.35
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cash Price |
$285.12
|
| Rate for Payer: Cigna Commercial |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$456.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$456.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$256.61
|
| Rate for Payer: Multiplan Commercial |
$530.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$256.61
|
| Rate for Payer: United Healthcare Commercial |
$541.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.61
|
| Rate for Payer: United Healthcare VA CCN |
$256.61
|
|
|
MM MAMMO DX INCL CAD UNILAT
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
CPT 77065 26
|
| Hospital Charge Code |
9727706501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$409.84 |
| Rate for Payer: Aetna of VT Commercial |
$409.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.41
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cash Price |
$218.00
|
| Rate for Payer: Cigna Commercial |
$54.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.19
|
| Rate for Payer: Multiplan Commercial |
$405.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.19
|
| Rate for Payer: United Healthcare Commercial |
$55.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.19
|
| Rate for Payer: United Healthcare VA CCN |
$36.19
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 77067 26
|
| Hospital Charge Code |
9727706701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$349.33 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna of VT Commercial |
$448.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$401.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.60
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$377.60
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$401.20
|
| Rate for Payer: United Healthcare Commercial |
$448.40
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
OP
|
$598.69
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$123.07 |
| Max. Negotiated Rate |
$568.76 |
| Rate for Payer: Aetna of VT Commercial |
$568.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$484.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$269.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.96
|
| Rate for Payer: Cash Price |
$299.35
|
| Rate for Payer: Cash Price |
$299.35
|
| Rate for Payer: Cigna Commercial |
$478.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.41
|
| Rate for Payer: Multiplan Commercial |
$556.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$269.41
|
| Rate for Payer: United Healthcare Commercial |
$568.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.07
|
| Rate for Payer: United Healthcare VA CCN |
$269.41
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
IP
|
$598.69
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$443.09 |
| Max. Negotiated Rate |
$568.76 |
| Rate for Payer: Aetna of VT Commercial |
$568.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$443.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$443.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$502.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$478.95
|
| Rate for Payer: Cash Price |
$299.35
|
| Rate for Payer: Cigna Commercial |
$478.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.95
|
| Rate for Payer: Multiplan Commercial |
$556.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.89
|
| Rate for Payer: United Healthcare Commercial |
$568.76
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
IP
|
$523.20
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
4017706701
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$387.22 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.56
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
OP
|
$523.20
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
4017706701
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$231.73 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.94
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare VA CCN |
$235.44
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 77067 26
|
| Hospital Charge Code |
9727706701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna of VT Commercial |
$448.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$422.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$422.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$284.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$401.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$382.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.24
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$377.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$377.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.40
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$401.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.40
|
| Rate for Payer: United Healthcare Commercial |
$448.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.40
|
| Rate for Payer: United Healthcare VA CCN |
$212.40
|
|
|
MM MAMMO SCR INCL CAD BILAT
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 77067 26
|
| Hospital Charge Code |
9727706701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$443.68 |
| Rate for Payer: Aetna of VT Commercial |
$443.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.65
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$51.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.24
|
| Rate for Payer: Multiplan Commercial |
$438.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.25
|
| Rate for Payer: United Healthcare Commercial |
$52.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.25
|
| Rate for Payer: United Healthcare VA CCN |
$34.25
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Facility
|
OP
|
$523.20
|
|
|
Service Code
|
CPT 77067 52|LT
|
| Hospital Charge Code |
40377067LT
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$231.73 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.94
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
| Rate for Payer: United Healthcare VA CCN |
$235.44
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 77067 26
|
| Hospital Charge Code |
9727706702
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$400.04 |
| Rate for Payer: Aetna of VT Commercial |
$79.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.65
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$51.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.24
|
| Rate for Payer: Multiplan Commercial |
$79.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.25
|
| Rate for Payer: United Healthcare Commercial |
$52.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.25
|
| Rate for Payer: United Healthcare VA CCN |
$34.25
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 77067 52|26
|
| Hospital Charge Code |
9727706702
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna of VT Commercial |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.58
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$79.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$80.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.25
|
| Rate for Payer: United Healthcare VA CCN |
$38.25
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Facility
|
OP
|
$523.20
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
4037706702
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$123.07 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$231.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$400.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$314.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$235.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$415.94
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$235.44
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$235.44
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.07
|
| Rate for Payer: United Healthcare VA CCN |
$235.44
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 77067 52|26
|
| Hospital Charge Code |
9727706702
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.91 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna of VT Commercial |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$68.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$79.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.25
|
| Rate for Payer: United Healthcare Commercial |
$80.75
|
|
|
MM MAMMO SCR INCL CAD UNILAT
|
Facility
|
IP
|
$523.20
|
|
|
Service Code
|
CPT 77067 52|RT
|
| Hospital Charge Code |
40377067RT
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$387.22 |
| Max. Negotiated Rate |
$497.04 |
| Rate for Payer: Aetna of VT Commercial |
$497.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$387.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$444.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$418.56
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$418.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$418.56
|
| Rate for Payer: Multiplan Commercial |
$486.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$444.72
|
| Rate for Payer: United Healthcare Commercial |
$497.04
|
|
