|
US ABDL AORTA SCREEN AAA
|
Facility
|
OP
|
$542.85
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
4027670601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.43 |
| Max. Negotiated Rate |
$515.71 |
| Rate for Payer: Aetna of VT Commercial |
$515.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$240.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$326.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$439.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$431.57
|
| Rate for Payer: Cash Price |
$271.42
|
| Rate for Payer: Cash Price |
$271.42
|
| Rate for Payer: Cigna Commercial |
$434.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$504.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare Commercial |
$515.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare VA CCN |
$244.28
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
IP
|
$542.85
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
4027670601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$401.76 |
| Max. Negotiated Rate |
$515.71 |
| Rate for Payer: Aetna of VT Commercial |
$515.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$461.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$455.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$434.28
|
| Rate for Payer: Cash Price |
$271.42
|
| Rate for Payer: Cigna Commercial |
$434.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$434.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$434.28
|
| Rate for Payer: Multiplan Commercial |
$504.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$461.42
|
| Rate for Payer: United Healthcare Commercial |
$515.71
|
|
|
US ABDL AORTA SCREEN AAA
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
9727670601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$350.92 |
| Rate for Payer: Aetna of VT Commercial |
$233.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.72
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$155.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.30
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.29
|
| Rate for Payer: United Healthcare Commercial |
$157.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.29
|
| Rate for Payer: United Healthcare VA CCN |
$102.29
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
9727670601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.16
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare VA CCN |
$111.60
|
|
|
US ABDL AORTA SCREEN AAA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
9727670601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.40
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
|
|
US ABDOMINAL COMPLETE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 76700 26
|
| Hospital Charge Code |
9727670001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.83
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.85
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.85
|
| Rate for Payer: United Healthcare VA CCN |
$50.85
|
|
|
US ABDOMINAL COMPLETE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 76700 26
|
| Hospital Charge Code |
9727670001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna of VT Commercial |
$107.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.40
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.05
|
| Rate for Payer: United Healthcare Commercial |
$107.35
|
|
|
US ABDOMINAL COMPLETE
|
Facility
|
OP
|
$899.58
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
4027670001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$340.59 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$340.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$340.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$541.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$728.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$715.17
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.81
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.81
|
| Rate for Payer: United Healthcare VA CCN |
$404.81
|
|
|
US ABDOMINAL COMPLETE
|
Facility
|
IP
|
$899.58
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
4027670001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$665.78 |
| Max. Negotiated Rate |
$854.60 |
| Rate for Payer: Aetna of VT Commercial |
$854.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$755.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.66
|
| Rate for Payer: Cash Price |
$449.79
|
| Rate for Payer: Cigna Commercial |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.66
|
| Rate for Payer: Multiplan Commercial |
$836.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.64
|
| Rate for Payer: United Healthcare Commercial |
$854.60
|
|
|
US ABDOMINAL COMPLETE
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 76700 26
|
| Hospital Charge Code |
9727670001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$340.59 |
| Rate for Payer: Aetna of VT Commercial |
$106.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$340.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$340.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.77
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$54.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.19
|
| Rate for Payer: Multiplan Commercial |
$105.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.19
|
| Rate for Payer: United Healthcare Commercial |
$55.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.19
|
| Rate for Payer: United Healthcare VA CCN |
$36.19
|
|
|
US ABDOMINAL LIMITED
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 76705 26
|
| Hospital Charge Code |
9727670501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
US ABDOMINAL LIMITED
|
Facility
|
OP
|
$718.63
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
4027670501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$682.70 |
| Rate for Payer: Aetna of VT Commercial |
$682.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$318.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$432.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$610.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$323.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$571.31
|
| Rate for Payer: Cash Price |
$359.32
|
| Rate for Payer: Cash Price |
$359.32
|
| Rate for Payer: Cigna Commercial |
$574.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$574.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$574.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$323.38
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$610.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$323.38
|
| Rate for Payer: United Healthcare Commercial |
$682.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.38
|
| Rate for Payer: United Healthcare VA CCN |
$323.38
|
|
|
US ABDOMINAL LIMITED
|
Facility
|
IP
|
$718.63
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
4027670501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$531.86 |
| Max. Negotiated Rate |
$682.70 |
| Rate for Payer: Aetna of VT Commercial |
$682.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$531.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$531.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$610.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$603.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.90
|
| Rate for Payer: Cash Price |
$359.32
|
| Rate for Payer: Cigna Commercial |
$574.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$574.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$574.90
|
| Rate for Payer: Multiplan Commercial |
$668.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$610.84
|
| Rate for Payer: United Healthcare Commercial |
$682.70
|
|
|
US ABDOMINAL LIMITED
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 76705 26
|
| Hospital Charge Code |
9727670501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$258.44 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$39.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.33
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.33
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.33
|
| Rate for Payer: United Healthcare VA CCN |
$26.33
|
|
|
US ABDOMINAL LIMITED
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 76705 26
|
| Hospital Charge Code |
9727670501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
US biopsy
|
Facility
|
IP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,758.55 |
| Max. Negotiated Rate |
$2,257.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,257.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,758.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,758.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,019.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,995.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,900.88
|
| Rate for Payer: Cash Price |
$1,188.05
|
| Rate for Payer: Cigna Commercial |
$1,900.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,900.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,900.88
|
| Rate for Payer: Multiplan Commercial |
$2,209.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,019.68
|
| Rate for Payer: United Healthcare Commercial |
$2,257.30
|
|
|
US biopsy
|
Facility
|
OP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
4021908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,052.37 |
| Max. Negotiated Rate |
$2,257.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,257.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,052.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,128.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,430.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,019.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,924.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,069.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,889.00
|
| Rate for Payer: Cash Price |
$1,188.05
|
| Rate for Payer: Cigna Commercial |
$1,900.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,900.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,900.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,069.24
|
| Rate for Payer: Multiplan Commercial |
$2,209.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,019.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,069.24
|
| Rate for Payer: United Healthcare Commercial |
$2,257.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,069.24
|
| Rate for Payer: United Healthcare VA CCN |
$1,069.24
|
|
|
US biopsy prostate
|
Facility
|
OP
|
$1,096.14
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
4025570001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.48 |
| Max. Negotiated Rate |
$1,041.33 |
| Rate for Payer: Aetna of VT Commercial |
$1,041.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$982.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$485.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$982.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$659.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$931.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$887.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$493.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$871.43
|
| Rate for Payer: Cash Price |
$548.07
|
| Rate for Payer: Cigna Commercial |
$876.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$876.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$876.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$493.26
|
| Rate for Payer: Multiplan Commercial |
$1,019.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$493.26
|
| Rate for Payer: United Healthcare Commercial |
$1,041.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$493.26
|
| Rate for Payer: United Healthcare VA CCN |
$493.26
|
|
|
US biopsy prostate
|
Facility
|
IP
|
$1,096.14
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
4025570001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$811.25 |
| Max. Negotiated Rate |
$1,041.33 |
| Rate for Payer: Aetna of VT Commercial |
$1,041.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$811.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$811.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$931.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$920.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$876.91
|
| Rate for Payer: Cash Price |
$548.07
|
| Rate for Payer: Cigna Commercial |
$876.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$876.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$876.91
|
| Rate for Payer: Multiplan Commercial |
$1,019.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$931.72
|
| Rate for Payer: United Healthcare Commercial |
$1,041.33
|
|
|
US BREAST LIMITED BILAT
|
Facility
|
IP
|
$516.17
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
4027664250
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.02 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna of VT Commercial |
$490.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.94
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna Commercial |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.94
|
| Rate for Payer: Multiplan Commercial |
$480.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.74
|
| Rate for Payer: United Healthcare Commercial |
$490.36
|
|
|
US BREAST LIMITED BILAT
|
Facility
|
OP
|
$516.17
|
|
|
Service Code
|
CPT 76642 50
|
| Hospital Charge Code |
4027664250
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.61 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna of VT Commercial |
$490.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$310.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$418.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.36
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna Commercial |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.28
|
| Rate for Payer: Multiplan Commercial |
$480.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$232.28
|
| Rate for Payer: United Healthcare Commercial |
$490.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.28
|
| Rate for Payer: United Healthcare VA CCN |
$232.28
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 76642 26
|
| Hospital Charge Code |
9727664201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$258.29 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna of VT Commercial |
$331.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.20
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.20
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.65
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
IP
|
$516.17
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
40276642RT
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.02 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna of VT Commercial |
$490.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.94
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna Commercial |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.94
|
| Rate for Payer: Multiplan Commercial |
$480.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.74
|
| Rate for Payer: United Healthcare Commercial |
$490.36
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
OP
|
$516.17
|
|
|
Service Code
|
CPT 76642 RT
|
| Hospital Charge Code |
40276642RT
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.61 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna of VT Commercial |
$490.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$310.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$418.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.36
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna Commercial |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.28
|
| Rate for Payer: Multiplan Commercial |
$480.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$232.28
|
| Rate for Payer: United Healthcare Commercial |
$490.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.28
|
| Rate for Payer: United Healthcare VA CCN |
$232.28
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
IP
|
$516.17
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
40276642LT
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.02 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna of VT Commercial |
$490.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$382.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$433.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$412.94
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna Commercial |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.94
|
| Rate for Payer: Multiplan Commercial |
$480.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.74
|
| Rate for Payer: United Healthcare Commercial |
$490.36
|
|
