|
MM TOMO MAMMO DX UNILAT/BILAT
|
Facility
|
OP
|
$252.30
|
|
|
Service Code
|
HCPCS G0279
|
| Hospital Charge Code |
4010027901
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$239.69 |
| Rate for Payer: Aetna of VT Commercial |
$239.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$151.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$214.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$204.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.58
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Cigna Commercial |
$201.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$201.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$201.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$113.53
|
| Rate for Payer: Multiplan Commercial |
$234.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$113.53
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.53
|
| Rate for Payer: United Healthcare VA CCN |
$113.53
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9822370001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna of VT Commercial |
$824.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.16
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$352.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.27
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
5102370001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$1,280.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,280.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,220.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,220.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.16
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$352.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.27
|
| Rate for Payer: Multiplan Commercial |
$1,266.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
IP
|
$1,362.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
5102370001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,008.02 |
| Max. Negotiated Rate |
$1,293.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,293.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,008.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,008.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,157.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,144.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,089.60
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$1,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,089.60
|
| Rate for Payer: Multiplan Commercial |
$1,266.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,157.70
|
| Rate for Payer: United Healthcare Commercial |
$1,293.90
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$649.07 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Aetna of VT Commercial |
$833.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$745.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.60
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$701.60
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$745.45
|
| Rate for Payer: United Healthcare Commercial |
$833.15
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$388.42 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Aetna of VT Commercial |
$833.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$388.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$527.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$745.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$710.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$394.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$697.22
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$701.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$394.65
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$745.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$394.65
|
| Rate for Payer: United Healthcare Commercial |
$833.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.65
|
| Rate for Payer: United Healthcare VA CCN |
$394.65
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$824.38 |
| Rate for Payer: Aetna of VT Commercial |
$824.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.16
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$352.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.27
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
OP
|
$2,239.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$2,127.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,127.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,005.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$991.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,005.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,347.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,903.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,813.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,007.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,780.01
|
| Rate for Payer: Cash Price |
$1,119.50
|
| Rate for Payer: Cigna Commercial |
$1,791.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,791.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,791.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,007.55
|
| Rate for Payer: Multiplan Commercial |
$2,082.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,903.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,007.55
|
| Rate for Payer: United Healthcare Commercial |
$2,127.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,007.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,007.55
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
IP
|
$2,239.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,657.08 |
| Max. Negotiated Rate |
$2,127.05 |
| Rate for Payer: Aetna of VT Commercial |
$2,127.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,657.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,657.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,903.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,119.50
|
| Rate for Payer: Cigna Commercial |
$1,791.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,791.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,791.20
|
| Rate for Payer: Multiplan Commercial |
$2,082.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,903.15
|
| Rate for Payer: United Healthcare Commercial |
$2,127.05
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
OP
|
$1,362.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
5102370001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$603.23 |
| Max. Negotiated Rate |
$1,293.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,293.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,220.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$603.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,220.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$819.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,157.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,103.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$612.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,082.79
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$1,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,089.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,089.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$612.90
|
| Rate for Payer: Multiplan Commercial |
$1,266.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,157.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$612.90
|
| Rate for Payer: United Healthcare Commercial |
$1,293.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$612.90
|
| Rate for Payer: United Healthcare VA CCN |
$612.90
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9822370001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$388.42 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Aetna of VT Commercial |
$833.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$388.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$785.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$527.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$745.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$710.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$394.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$697.22
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$701.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$394.65
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$745.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$394.65
|
| Rate for Payer: United Healthcare Commercial |
$833.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.65
|
| Rate for Payer: United Healthcare VA CCN |
$394.65
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9822370001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$649.07 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Aetna of VT Commercial |
$833.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$649.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$649.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$745.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$736.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.60
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$701.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$701.60
|
| Rate for Payer: Multiplan Commercial |
$815.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$745.45
|
| Rate for Payer: United Healthcare Commercial |
$833.15
|
|
|
MNPJ ANES SHO JT FIXJ APRATS
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
9602370001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.26 |
| Max. Negotiated Rate |
$2,104.66 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,005.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,005.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$331.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.16
|
| Rate for Payer: Cash Price |
$1,119.50
|
| Rate for Payer: Cash Price |
$1,119.50
|
| Rate for Payer: Cigna Commercial |
$352.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$309.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$309.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.27
|
| Rate for Payer: Multiplan Commercial |
$2,082.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare Commercial |
$286.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.26
|
| Rate for Payer: United Healthcare VA CCN |
$186.26
|
|
|
MOBILIZATION OF COLON
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
9824413901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna of VT Commercial |
$400.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$186.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$254.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$335.49
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$337.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$189.90
|
| Rate for Payer: Multiplan Commercial |
$392.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$358.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$189.90
|
| Rate for Payer: United Healthcare Commercial |
$400.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.90
|
| Rate for Payer: United Healthcare VA CCN |
$189.90
|
|
|
MOBILIZATION OF COLON
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
9824413901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$107.81 |
| Max. Negotiated Rate |
$396.68 |
| Rate for Payer: Aetna of VT Commercial |
$396.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.46
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$197.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.81
|
| Rate for Payer: Multiplan Commercial |
$392.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.81
|
| Rate for Payer: United Healthcare Commercial |
$165.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.81
|
| Rate for Payer: United Healthcare VA CCN |
$107.81
|
|
|
MOBILIZATION OF COLON
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
9824413901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$312.32 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna of VT Commercial |
$400.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$312.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$358.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.60
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$337.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.60
|
| Rate for Payer: Multiplan Commercial |
$392.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$358.70
|
| Rate for Payer: United Healthcare Commercial |
$400.90
|
|
|
MOD SED EACH ADD 15 MIN
|
Facility
|
IP
|
$303.59
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
3799915301
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$288.41 |
| Rate for Payer: Aetna of VT Commercial |
$288.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.87
|
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Cigna Commercial |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.87
|
| Rate for Payer: Multiplan Commercial |
$282.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.05
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
|
|
MOD SED EACH ADD 15 MIN
|
Facility
|
OP
|
$303.59
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
3799915301
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$288.41 |
| Rate for Payer: Aetna of VT Commercial |
$288.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$258.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$241.35
|
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Cigna Commercial |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.62
|
| Rate for Payer: Multiplan Commercial |
$282.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.62
|
| Rate for Payer: United Healthcare Commercial |
$288.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.62
|
| Rate for Payer: United Healthcare VA CCN |
$136.62
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Facility
|
OP
|
$258.62
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
3799915701
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$114.54 |
| Max. Negotiated Rate |
$245.69 |
| Rate for Payer: Aetna of VT Commercial |
$245.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.60
|
| Rate for Payer: Cash Price |
$129.31
|
| Rate for Payer: Cigna Commercial |
$206.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.38
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.38
|
| Rate for Payer: United Healthcare Commercial |
$245.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.38
|
| Rate for Payer: United Healthcare VA CCN |
$116.38
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Facility
|
IP
|
$258.62
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
3799915701
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$245.69 |
| Rate for Payer: Aetna of VT Commercial |
$245.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.90
|
| Rate for Payer: Cash Price |
$129.31
|
| Rate for Payer: Cigna Commercial |
$206.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.90
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.83
|
| Rate for Payer: United Healthcare Commercial |
$245.69
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Professional
|
Both
|
$258.62
|
|
|
Service Code
|
CPT 99157
|
| Hospital Charge Code |
3799915701
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Aetna of VT Commercial |
$243.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.09
|
| Rate for Payer: Cash Price |
$129.31
|
| Rate for Payer: Cash Price |
$129.31
|
| Rate for Payer: Cigna Commercial |
$65.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.21
|
| Rate for Payer: Multiplan Commercial |
$240.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.21
|
| Rate for Payer: United Healthcare Commercial |
$81.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.21
|
| Rate for Payer: United Healthcare VA CCN |
$53.21
|
|
|
MOD SED OTH PHYS/QHP <5 YRS
|
Facility
|
OP
|
$248.16
|
|
|
Service Code
|
CPT 99155
|
| Hospital Charge Code |
3799915501
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna of VT Commercial |
$235.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.29
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.67
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.67
|
| Rate for Payer: United Healthcare VA CCN |
$111.67
|
|
|
MOD SED OTH PHYS/QHP <5 YRS
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
CPT 99155
|
| Hospital Charge Code |
3799915501
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$183.66 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna of VT Commercial |
$235.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.53
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.53
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
9819915602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$248.16 |
| Rate for Payer: Aetna of VT Commercial |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$96.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.57
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$82.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.58
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.58
|
| Rate for Payer: United Healthcare Commercial |
$105.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.58
|
| Rate for Payer: United Healthcare VA CCN |
$68.58
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
9819915602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna of VT Commercial |
$250.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$211.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$245.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$250.80
|
|
