|
NM BLD POOL PLANAR REST/STRESS
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 78472 26
|
| Hospital Charge Code |
9727847201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$715.92 |
| Rate for Payer: Aetna of VT Commercial |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$715.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$715.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.04
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$65.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.97
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.97
|
| Rate for Payer: United Healthcare Commercial |
$66.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.97
|
| Rate for Payer: United Healthcare VA CCN |
$42.97
|
|
|
NM BLD POOL PLANAR REST/STRESS
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 78472 26
|
| Hospital Charge Code |
9727847201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.20
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
|
|
NM BLD POOL PLANAR REST/STRESS
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 78472 26
|
| Hospital Charge Code |
9727847201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.55
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare VA CCN |
$62.55
|
|
|
NM BONE & JNT IMAGING LTD AREA
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 78300 26
|
| Hospital Charge Code |
9727830001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Aetna of VT Commercial |
$361.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$340.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$340.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.10
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$353.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.00
|
| Rate for Payer: United Healthcare Commercial |
$361.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.00
|
| Rate for Payer: United Healthcare VA CCN |
$171.00
|
|
|
NM BONE & JNT IMAGING LTD AREA
|
Facility
|
IP
|
$1,452.07
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
3417830001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,074.68 |
| Max. Negotiated Rate |
$1,379.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,379.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,074.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,074.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,234.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,219.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,161.66
|
| Rate for Payer: Cash Price |
$726.04
|
| Rate for Payer: Cigna Commercial |
$1,161.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,161.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,161.66
|
| Rate for Payer: Multiplan Commercial |
$1,350.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.26
|
| Rate for Payer: United Healthcare Commercial |
$1,379.47
|
|
|
NM BONE & JNT IMAGING LTD AREA
|
Facility
|
OP
|
$1,452.07
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
3417830001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.12 |
| Max. Negotiated Rate |
$1,379.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,379.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$643.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$874.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,234.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,176.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$653.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,154.40
|
| Rate for Payer: Cash Price |
$726.04
|
| Rate for Payer: Cash Price |
$726.04
|
| Rate for Payer: Cigna Commercial |
$1,161.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,161.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,161.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$653.43
|
| Rate for Payer: Multiplan Commercial |
$1,350.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$653.43
|
| Rate for Payer: United Healthcare Commercial |
$1,379.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$653.43
|
| Rate for Payer: United Healthcare VA CCN |
$653.43
|
|
|
NM BONE & JNT IMAGING LTD AREA
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
CPT 78300 26
|
| Hospital Charge Code |
9727830001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$771.01 |
| Rate for Payer: Aetna of VT Commercial |
$357.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.05
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$41.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.62
|
| Rate for Payer: Multiplan Commercial |
$353.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare Commercial |
$42.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.62
|
| Rate for Payer: United Healthcare VA CCN |
$27.62
|
|
|
NM BONE & JNT IMAGING LTD AREA
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 78300 26
|
| Hospital Charge Code |
9727830001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$281.24 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Aetna of VT Commercial |
$361.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.00
|
| Rate for Payer: Multiplan Commercial |
$353.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.00
|
| Rate for Payer: United Healthcare Commercial |
$361.00
|
|
|
NM BONE & JNT IMG WHOLE BODY
|
Facility
|
OP
|
$1,950.85
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
3417830601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$864.03 |
| Max. Negotiated Rate |
$1,853.31 |
| Rate for Payer: Aetna of VT Commercial |
$1,853.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$996.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$864.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$996.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,174.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,658.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,580.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$877.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,550.93
|
| Rate for Payer: Cash Price |
$975.42
|
| Rate for Payer: Cash Price |
$975.42
|
| Rate for Payer: Cigna Commercial |
$1,560.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,560.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,560.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$877.88
|
| Rate for Payer: Multiplan Commercial |
$1,814.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,658.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$877.88
|
| Rate for Payer: United Healthcare Commercial |
$1,853.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$877.88
|
| Rate for Payer: United Healthcare VA CCN |
$877.88
|
|
|
NM BONE & JNT IMG WHOLE BODY
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 78306 26
|
| Hospital Charge Code |
9727830601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$425.56 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$425.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$460.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
|
|
NM BONE & JNT IMG WHOLE BODY
|
Facility
|
IP
|
$1,950.85
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
3417830601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,443.82 |
| Max. Negotiated Rate |
$1,853.31 |
| Rate for Payer: Aetna of VT Commercial |
$1,853.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,443.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,443.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,658.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,638.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,560.68
|
| Rate for Payer: Cash Price |
$975.42
|
| Rate for Payer: Cigna Commercial |
$1,560.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,560.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,560.68
|
| Rate for Payer: Multiplan Commercial |
$1,814.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,658.22
|
| Rate for Payer: United Healthcare Commercial |
$1,853.31
|
|
|
NM BONE & JNT IMG WHOLE BODY
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 78306 26
|
| Hospital Charge Code |
9727830601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$254.67 |
| Max. Negotiated Rate |
$546.25 |
| Rate for Payer: Aetna of VT Commercial |
$546.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$254.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$515.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$346.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$488.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$465.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$457.12
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$460.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$460.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$488.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare Commercial |
$546.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.75
|
| Rate for Payer: United Healthcare VA CCN |
$258.75
|
|
|
NM BONE & JNT IMG WHOLE BODY
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
CPT 78306 26
|
| Hospital Charge Code |
9727830601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$996.21 |
| Rate for Payer: Aetna of VT Commercial |
$540.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$996.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$996.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.71
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$56.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$534.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$58.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
NM CAPSULOTOMY MIDTARSAL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 78264 26
|
| Hospital Charge Code |
9727826401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.04
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.40
|
| Rate for Payer: United Healthcare VA CCN |
$50.40
|
|
|
NM CAPSULOTOMY MIDTARSAL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 78264 26
|
| Hospital Charge Code |
9727826401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$82.89 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna of VT Commercial |
$106.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$106.40
|
|
|
NM CAPSULOTOMY MIDTARSAL
|
Facility
|
OP
|
$1,616.14
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$715.79 |
| Max. Negotiated Rate |
$1,535.33 |
| Rate for Payer: Aetna of VT Commercial |
$1,535.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,150.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$715.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,150.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$972.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,373.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,309.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$727.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,284.83
|
| Rate for Payer: Cash Price |
$808.07
|
| Rate for Payer: Cash Price |
$808.07
|
| Rate for Payer: Cigna Commercial |
$1,292.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,292.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,292.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$727.26
|
| Rate for Payer: Multiplan Commercial |
$1,503.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,373.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$727.26
|
| Rate for Payer: United Healthcare Commercial |
$1,535.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$727.26
|
| Rate for Payer: United Healthcare VA CCN |
$727.26
|
|
|
NM CAPSULOTOMY MIDTARSAL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 78264 26
|
| Hospital Charge Code |
9727826401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.90 |
| Max. Negotiated Rate |
$1,150.43 |
| Rate for Payer: Aetna of VT Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,150.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,150.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.25
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$52.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.90
|
| Rate for Payer: Multiplan Commercial |
$104.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.90
|
| Rate for Payer: United Healthcare Commercial |
$53.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.90
|
| Rate for Payer: United Healthcare VA CCN |
$34.90
|
|
|
NM CAPSULOTOMY MIDTARSAL
|
Facility
|
IP
|
$1,616.14
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
3417826401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,196.11 |
| Max. Negotiated Rate |
$1,535.33 |
| Rate for Payer: Aetna of VT Commercial |
$1,535.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,196.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,196.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,373.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,357.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,292.91
|
| Rate for Payer: Cash Price |
$808.07
|
| Rate for Payer: Cigna Commercial |
$1,292.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,292.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,292.91
|
| Rate for Payer: Multiplan Commercial |
$1,503.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,373.72
|
| Rate for Payer: United Healthcare Commercial |
$1,535.33
|
|
|
NM HEPATOBILIARY SYSTEM IMAGNG
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 78226 26
|
| Hospital Charge Code |
9727822601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
|
NM HEPATOBILIARY SYSTEM IMAGNG
|
Facility
|
IP
|
$1,729.62
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,280.09 |
| Max. Negotiated Rate |
$1,643.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,643.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,280.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,280.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,470.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,452.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,383.70
|
| Rate for Payer: Cash Price |
$864.81
|
| Rate for Payer: Cigna Commercial |
$1,383.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,383.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,383.70
|
| Rate for Payer: Multiplan Commercial |
$1,608.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,470.18
|
| Rate for Payer: United Healthcare Commercial |
$1,643.14
|
|
|
NM HEPATOBILIARY SYSTEM IMAGNG
|
Facility
|
OP
|
$1,729.62
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$766.05 |
| Max. Negotiated Rate |
$1,643.14 |
| Rate for Payer: Aetna of VT Commercial |
$1,643.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$766.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,041.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,470.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,400.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$778.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,375.05
|
| Rate for Payer: Cash Price |
$864.81
|
| Rate for Payer: Cash Price |
$864.81
|
| Rate for Payer: Cigna Commercial |
$1,383.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,383.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,383.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$778.33
|
| Rate for Payer: Multiplan Commercial |
$1,608.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,470.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$778.33
|
| Rate for Payer: United Healthcare Commercial |
$1,643.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$778.33
|
| Rate for Payer: United Healthcare VA CCN |
$778.33
|
|
|
NM HEPATOBILIARY SYSTEM IMAGNG
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 78226 26
|
| Hospital Charge Code |
9727822601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$1,136.18 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.85
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$49.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.64
|
| Rate for Payer: United Healthcare Commercial |
$50.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.64
|
| Rate for Payer: United Healthcare VA CCN |
$32.64
|
|
|
NM HEPATOBILIARY SYSTEM IMAGNG
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 78226 26
|
| Hospital Charge Code |
9727822601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
NM HEPATOBIL SYST IMAGE W/DRUG
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 78227 26
|
| Hospital Charge Code |
9727822701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$1,544.66 |
| Rate for Payer: Aetna of VT Commercial |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,544.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,544.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$55.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.41
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$59.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.74
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.74
|
| Rate for Payer: United Healthcare Commercial |
$61.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.74
|
| Rate for Payer: United Healthcare VA CCN |
$39.74
|
|
|
NM HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 78227 26
|
| Hospital Charge Code |
9727822701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare VA CCN |
$58.50
|
|
