|
US BREAST LIMITED UNILAT
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 76642 26
|
| Hospital Charge Code |
9727664201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$328.06 |
| Rate for Payer: Aetna of VT Commercial |
$328.06
|
| 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 |
$31.62
|
| 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 |
$42.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.25
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$46.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.70
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.70
|
| Rate for Payer: United Healthcare Commercial |
$47.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.70
|
| Rate for Payer: United Healthcare VA CCN |
$30.70
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
IP
|
$685.54
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4027664201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$507.37 |
| Max. Negotiated Rate |
$651.26 |
| Rate for Payer: Aetna of VT Commercial |
$651.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$507.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$507.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$575.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$548.43
|
| Rate for Payer: Cash Price |
$342.77
|
| Rate for Payer: Cigna Commercial |
$548.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$548.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$548.43
|
| Rate for Payer: Multiplan Commercial |
$637.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$582.71
|
| Rate for Payer: United Healthcare Commercial |
$651.26
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
OP
|
$685.54
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4027664201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.55 |
| Max. Negotiated Rate |
$651.26 |
| Rate for Payer: Aetna of VT Commercial |
$651.26
|
| 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 |
$303.63
|
| 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 |
$412.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$555.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$308.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.00
|
| Rate for Payer: Cash Price |
$342.77
|
| Rate for Payer: Cash Price |
$342.77
|
| Rate for Payer: Cigna Commercial |
$548.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$548.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$548.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$308.49
|
| Rate for Payer: Multiplan Commercial |
$637.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$582.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$308.49
|
| Rate for Payer: United Healthcare Commercial |
$651.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$308.49
|
| Rate for Payer: United Healthcare VA CCN |
$308.49
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 76642 26
|
| Hospital Charge Code |
9727664201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$154.57 |
| 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 |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$312.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.45
|
| 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: Martins Point Health Care Commercial |
$157.05
|
| Rate for Payer: Multiplan Commercial |
$324.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.05
|
| Rate for Payer: United Healthcare Commercial |
$331.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.05
|
| Rate for Payer: United Healthcare VA CCN |
$157.05
|
|
|
US BREAST LIMITED UNILAT
|
Facility
|
OP
|
$516.17
|
|
|
Service Code
|
CPT 76642 LT
|
| Hospital Charge Code |
40276642LT
|
|
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 CHEST REAL TIME W/IMG DOC
|
Facility
|
OP
|
$693.97
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$659.27 |
| Rate for Payer: Aetna of VT Commercial |
$659.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$417.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$551.71
|
| Rate for Payer: Cash Price |
$346.98
|
| Rate for Payer: Cash Price |
$346.98
|
| Rate for Payer: Cigna Commercial |
$555.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.29
|
| Rate for Payer: Multiplan Commercial |
$645.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.29
|
| Rate for Payer: United Healthcare Commercial |
$659.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.29
|
| Rate for Payer: United Healthcare VA CCN |
$312.29
|
|
|
US CHEST REAL TIME W/IMG DOC
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
9727660401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.80
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
|
|
US CHEST REAL TIME W/IMG DOC
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
9727660401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$221.84 |
| Rate for Payer: Aetna of VT Commercial |
$221.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.57
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$38.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.69
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.69
|
| Rate for Payer: United Healthcare Commercial |
$39.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.69
|
| Rate for Payer: United Healthcare VA CCN |
$25.69
|
|
|
US CHEST REAL TIME W/IMG DOC
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
9727660401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna of VT Commercial |
$224.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$142.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$200.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.62
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$219.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.20
|
| Rate for Payer: United Healthcare VA CCN |
$106.20
|
|
|
US CHEST REAL TIME W/IMG DOC
|
Facility
|
IP
|
$693.97
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$513.61 |
| Max. Negotiated Rate |
$659.27 |
| Rate for Payer: Aetna of VT Commercial |
$659.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$513.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$513.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$589.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$582.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.18
|
| Rate for Payer: Cash Price |
$346.98
|
| Rate for Payer: Cigna Commercial |
$555.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.18
|
| Rate for Payer: Multiplan Commercial |
$645.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$589.87
|
| Rate for Payer: United Healthcare Commercial |
$659.27
|
|
|
US COMPL JNT R-T W/IMG INTERPR
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
9727688101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.43 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of VT Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.40
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.05
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
|
|
US COMPL JNT R-T W/IMG INTERPR
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
9727688101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of VT Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.73
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$106.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$106.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.85
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.85
|
| Rate for Payer: United Healthcare VA CCN |
$59.85
|
|
|
US COMPL JNT R-T W/IMG INTERPR
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
9727688101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$125.43 |
| Rate for Payer: Aetna of VT Commercial |
$125.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$125.43
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$77.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.82
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.83
|
| Rate for Payer: United Healthcare Commercial |
$78.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.83
|
| Rate for Payer: United Healthcare VA CCN |
$50.83
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
IP
|
$434.28
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.41 |
| Max. Negotiated Rate |
$412.57 |
| Rate for Payer: Aetna of VT Commercial |
$412.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.42
|
| Rate for Payer: Cash Price |
$217.14
|
| Rate for Payer: Cigna Commercial |
$347.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.42
|
| Rate for Payer: Multiplan Commercial |
$403.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.14
|
| Rate for Payer: United Healthcare Commercial |
$412.57
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
OP
|
$434.28
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
4027688101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$412.57 |
| Rate for Payer: Aetna of VT Commercial |
$412.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.25
|
| Rate for Payer: Cash Price |
$217.14
|
| Rate for Payer: Cash Price |
$217.14
|
| Rate for Payer: Cigna Commercial |
$347.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.43
|
| Rate for Payer: Multiplan Commercial |
$403.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.43
|
| Rate for Payer: United Healthcare Commercial |
$412.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.43
|
| Rate for Payer: United Healthcare VA CCN |
$195.43
|
|
|
US DUPLEX SCN EXTRACRANIAL BI
|
Facility
|
IP
|
$993.82
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9209388001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.53 |
| Max. Negotiated Rate |
$944.13 |
| Rate for Payer: Aetna of VT Commercial |
$944.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$735.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$735.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$844.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$834.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$795.06
|
| Rate for Payer: Cash Price |
$496.91
|
| Rate for Payer: Cigna Commercial |
$795.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$795.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$795.06
|
| Rate for Payer: Multiplan Commercial |
$924.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$844.75
|
| Rate for Payer: United Healthcare Commercial |
$944.13
|
|
|
US DUPLEX SCN EXTRACRANIAL BI
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
9729388001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$723.30 |
| Rate for Payer: Aetna of VT Commercial |
$103.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$723.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$723.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.18
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$41.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.23
|
| Rate for Payer: United Healthcare Commercial |
$54.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.23
|
| Rate for Payer: United Healthcare VA CCN |
$35.23
|
|
|
US DUPLEX SCN EXTRACRANIAL BI
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
9729388001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna of VT Commercial |
$104.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.45
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.50
|
| Rate for Payer: United Healthcare VA CCN |
$49.50
|
|
|
US DUPLEX SCN EXTRACRANIAL BI
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
9729388001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna of VT Commercial |
$104.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$93.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$102.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.50
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
|
|
US DUPLEX SCN EXTRACRANIAL BI
|
Facility
|
OP
|
$993.82
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9209388001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$440.16 |
| Max. Negotiated Rate |
$944.13 |
| Rate for Payer: Aetna of VT Commercial |
$944.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$890.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$890.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$598.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$844.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$804.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$447.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$790.09
|
| Rate for Payer: Cash Price |
$496.91
|
| Rate for Payer: Cigna Commercial |
$795.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$795.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$795.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$447.22
|
| Rate for Payer: Multiplan Commercial |
$924.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$844.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$447.22
|
| Rate for Payer: United Healthcare Commercial |
$944.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$447.22
|
| Rate for Payer: United Healthcare VA CCN |
$447.22
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
OP
|
$614.84
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9209388201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$272.31 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$498.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$276.68
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare VA CCN |
$276.68
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
9729388201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.40
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.55
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.55
|
| Rate for Payer: United Healthcare VA CCN |
$161.55
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
IP
|
$614.84
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
92093882RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$455.04 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$516.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$491.87
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
OP
|
$614.84
|
|
|
Service Code
|
CPT 93882 LT
|
| Hospital Charge Code |
92093882LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$272.31 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna of VT Commercial |
$584.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$550.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$522.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$498.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$276.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.80
|
| Rate for Payer: Cash Price |
$307.42
|
| Rate for Payer: Cigna Commercial |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$491.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$491.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$276.68
|
| Rate for Payer: Multiplan Commercial |
$571.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare Commercial |
$584.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.68
|
| Rate for Payer: United Healthcare VA CCN |
$276.68
|
|
|
US DUPLEX SCN EXTRACRANIAL LTD
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
9729388201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$265.70 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna of VT Commercial |
$341.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$265.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.20
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$333.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.15
|
| Rate for Payer: United Healthcare Commercial |
$341.05
|
|
