|
OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
510Q009101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$61.78 |
| Rate for Payer: Aetna of VT Commercial |
$37.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.78
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.81
|
| Rate for Payer: Multiplan Commercial |
$37.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.12
|
| Rate for Payer: United Healthcare VA CCN |
$17.12
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
510Q009101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of VT Commercial |
$38.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.80
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$32.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$37.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$38.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.00
|
| Rate for Payer: United Healthcare VA CCN |
$18.00
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
510Q009101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna of VT Commercial |
$38.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$32.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$37.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$38.00
|
|
|
OB US < 14 WKS ADDL FETUS
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
5107680201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$411.72 |
| Rate for Payer: Aetna of VT Commercial |
$411.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.05
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.22
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare Commercial |
$88.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare VA CCN |
$57.22
|
|
|
OB US < 14 WKS ADDL FETUS
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$618.52 |
| Rate for Payer: Aetna of VT Commercial |
$618.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.05
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.22
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare Commercial |
$88.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare VA CCN |
$57.22
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
5107680201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.40
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
5107680201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
OB US < 14 WKS ADDL FETUS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna of VT Commercial |
$206.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.05
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.22
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare Commercial |
$88.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.22
|
| Rate for Payer: United Healthcare VA CCN |
$57.22
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$291.43 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$291.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$396.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$523.11
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$296.10
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare VA CCN |
$296.10
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
9607680201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$486.99 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$526.40
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
5107680101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.91 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$660.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.40
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,192.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,124.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$755.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,066.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$564.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$997.73
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.75
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,066.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$564.75
|
| Rate for Payer: United Healthcare VA CCN |
$564.75
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna of VT Commercial |
$340.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$170.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.56
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare VA CCN |
$111.55
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
5107680101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$839.42 |
| Rate for Payer: Aetna of VT Commercial |
$839.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.00
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$170.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.56
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare VA CCN |
$111.55
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
5107680101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna of VT Commercial |
$848.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$395.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$800.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$537.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$759.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.93
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$401.85
|
| Rate for Payer: Multiplan Commercial |
$830.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$759.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare Commercial |
$848.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.85
|
| Rate for Payer: United Healthcare VA CCN |
$401.85
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna of VT Commercial |
$340.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$201.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$170.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.56
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.55
|
| Rate for Payer: United Healthcare VA CCN |
$111.55
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$928.83 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,192.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$928.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$928.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,066.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,054.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,004.00
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,004.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,004.00
|
| Rate for Payer: Multiplan Commercial |
$1,167.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,066.75
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.79
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.90
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare VA CCN |
$162.90
|
|
|
OB US < 14 WKS SINGLE FETUS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
9607680102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$267.92 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.60
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
|
|
OB US >= 14 WKS SNGL FETUS
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
9607680502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.25
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.95
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare VA CCN |
$139.95
|
|
|
OB US >= 14 WKS SNGL FETUS
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
5107680501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$368.05 |
| Max. Negotiated Rate |
$789.45 |
| Rate for Payer: Aetna of VT Commercial |
$789.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$744.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$368.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$744.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$500.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$706.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$673.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$373.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$660.64
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$664.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$664.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$664.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$373.95
|
| Rate for Payer: Multiplan Commercial |
$772.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$706.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.95
|
| Rate for Payer: United Healthcare Commercial |
$789.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.95
|
| Rate for Payer: United Healthcare VA CCN |
$373.95
|
|
|
OB US >= 14 WKS SNGL FETUS
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
9607680501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$1,072.54 |
| Rate for Payer: Aetna of VT Commercial |
$1,072.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$179.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.87
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$197.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.42
|
| Rate for Payer: Multiplan Commercial |
$1,061.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$128.42
|
| Rate for Payer: United Healthcare Commercial |
$197.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.42
|
| Rate for Payer: United Healthcare VA CCN |
$128.42
|
|
|
OB US >= 14 WKS SNGL FETUS
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
9607680502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.80
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
|
