|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
OP
|
$768.26
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
92093931LT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$340.26 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Aetna of VT Commercial |
$729.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$688.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$340.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$688.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$462.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$653.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$345.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$610.77
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Cigna Commercial |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$614.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$345.72
|
| Rate for Payer: Multiplan Commercial |
$714.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$653.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$345.72
|
| Rate for Payer: United Healthcare Commercial |
$729.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$345.72
|
| Rate for Payer: United Healthcare VA CCN |
$345.72
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
IP
|
$768.26
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
92093931RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$568.59 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Aetna of VT Commercial |
$729.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$653.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$645.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.61
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Cigna Commercial |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$614.61
|
| Rate for Payer: Multiplan Commercial |
$714.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$653.02
|
| Rate for Payer: United Healthcare Commercial |
$729.85
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
9729393101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$287.16 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna of VT Commercial |
$368.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$329.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.40
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$310.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$368.60
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
9209393101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
OP
|
$768.26
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
92093931RT
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$340.26 |
| Max. Negotiated Rate |
$729.85 |
| Rate for Payer: Aetna of VT Commercial |
$729.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$688.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$340.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$688.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$462.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$653.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$345.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$610.77
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Cigna Commercial |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$614.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$614.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$345.72
|
| Rate for Payer: Multiplan Commercial |
$714.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$653.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$345.72
|
| Rate for Payer: United Healthcare Commercial |
$729.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$345.72
|
| Rate for Payer: United Healthcare VA CCN |
$345.72
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
9729393101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$471.47 |
| Rate for Payer: Aetna of VT Commercial |
$364.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$471.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$471.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.27
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$25.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$360.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.34
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.34
|
| Rate for Payer: United Healthcare VA CCN |
$21.34
|
|
|
US DUPLEX SCN UPPER EXTREM UNI
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
9209393101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$752.96
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
4027688501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$557.27 |
| Max. Negotiated Rate |
$715.31 |
| Rate for Payer: Aetna of VT Commercial |
$715.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$557.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$557.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$640.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$632.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$602.37
|
| Rate for Payer: Cash Price |
$376.48
|
| Rate for Payer: Cigna Commercial |
$602.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$602.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$602.37
|
| Rate for Payer: Multiplan Commercial |
$700.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$640.02
|
| Rate for Payer: United Healthcare Commercial |
$715.31
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$752.96
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
4027688501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.49 |
| Max. Negotiated Rate |
$715.31 |
| Rate for Payer: Aetna of VT Commercial |
$715.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$453.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$640.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$609.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$338.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$598.60
|
| Rate for Payer: Cash Price |
$376.48
|
| Rate for Payer: Cash Price |
$376.48
|
| Rate for Payer: Cigna Commercial |
$602.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$602.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$602.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.83
|
| Rate for Payer: Multiplan Commercial |
$700.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$640.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$338.83
|
| Rate for Payer: United Healthcare Commercial |
$715.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$338.83
|
| Rate for Payer: United Healthcare VA CCN |
$338.83
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 76885 26
|
| Hospital Charge Code |
9727688501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$232.39 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Aetna of VT Commercial |
$298.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.20
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$251.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$251.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$251.20
|
| Rate for Payer: Multiplan Commercial |
$292.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$266.90
|
| Rate for Payer: United Healthcare Commercial |
$298.30
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 76885 26
|
| Hospital Charge Code |
9727688501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$139.07 |
| Max. Negotiated Rate |
$298.30 |
| Rate for Payer: Aetna of VT Commercial |
$298.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$266.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$141.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.63
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$251.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$251.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$251.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$141.30
|
| Rate for Payer: Multiplan Commercial |
$292.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$266.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.30
|
| Rate for Payer: United Healthcare Commercial |
$298.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.30
|
| Rate for Payer: United Healthcare VA CCN |
$141.30
|
|
|
US EXAM PELVIC COMPLETE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$317.67 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.86
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare Commercial |
$154.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare VA CCN |
$100.25
|
|
|
US EXAM PELVIC COMPLETE
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$976.66 |
| Rate for Payer: Aetna of VT Commercial |
$976.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.86
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare Commercial |
$154.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare VA CCN |
$100.25
|
|
|
US EXAM PELVIC COMPLETE
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
5107685601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$733.20 |
| Rate for Payer: Aetna of VT Commercial |
$733.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.86
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$153.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare Commercial |
$154.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.25
|
| Rate for Payer: United Healthcare VA CCN |
$100.25
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
5107685601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$345.46 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of VT Commercial |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$698.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$698.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$469.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$631.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$620.10
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$351.00
|
| Rate for Payer: United Healthcare Commercial |
$741.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$351.00
|
| Rate for Payer: United Healthcare VA CCN |
$351.00
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
5107685601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$577.28 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of VT Commercial |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.00
|
| Rate for Payer: United Healthcare Commercial |
$741.00
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$460.17 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$460.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$930.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$625.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$841.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$467.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$826.00
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$467.55
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$467.55
|
| Rate for Payer: United Healthcare VA CCN |
$467.55
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$768.96 |
| Max. Negotiated Rate |
$987.05 |
| Rate for Payer: Aetna of VT Commercial |
$987.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$883.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$872.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$831.20
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$831.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$831.20
|
| Rate for Payer: Multiplan Commercial |
$966.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$883.15
|
| Rate for Payer: United Healthcare Commercial |
$987.05
|
|
|
US EXAM PELVIC COMPLETE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
9607685602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$91.68 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna of VT Commercial |
$196.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.56
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.15
|
| Rate for Payer: Multiplan Commercial |
$192.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$196.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.15
|
| Rate for Payer: United Healthcare VA CCN |
$93.15
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
5107681901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$498.09 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Aetna of VT Commercial |
$639.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$498.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$498.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$565.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$538.40
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$538.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$538.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$538.40
|
| Rate for Payer: Multiplan Commercial |
$625.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.05
|
| Rate for Payer: United Healthcare Commercial |
$639.35
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$214.91 |
| Rate for Payer: Aetna of VT Commercial |
$194.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.10
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$124.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.11
|
| Rate for Payer: Multiplan Commercial |
$192.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.11
|
| Rate for Payer: United Healthcare Commercial |
$126.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.11
|
| Rate for Payer: United Healthcare VA CCN |
$82.11
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$389.75 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Aetna of VT Commercial |
$836.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$389.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$788.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$529.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$712.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$699.60
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$704.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$836.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.00
|
| Rate for Payer: United Healthcare VA CCN |
$396.00
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
5107681901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$632.62 |
| Rate for Payer: Aetna of VT Commercial |
$632.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.10
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$124.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.11
|
| Rate for Payer: Multiplan Commercial |
$625.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.11
|
| Rate for Payer: United Healthcare Commercial |
$126.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.11
|
| Rate for Payer: United Healthcare VA CCN |
$82.11
|
|
