|
US FETAL BIOPHY PROFIL W/O NST
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$153.20 |
| 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 |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.60
|
| 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: Multiplan Commercial |
$192.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.95
|
| Rate for Payer: United Healthcare Commercial |
$196.65
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.11 |
| Max. Negotiated Rate |
$827.20 |
| Rate for Payer: Aetna of VT Commercial |
$827.20
|
| 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 |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| 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 |
$818.40
|
| 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
|
$673.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
5107681901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.07 |
| 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 |
$602.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$298.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$602.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$405.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$572.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$545.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$302.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.03
|
| 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: Martins Point Health Care Commercial |
$302.85
|
| Rate for Payer: Multiplan Commercial |
$625.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$572.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$302.85
|
| Rate for Payer: United Healthcare Commercial |
$639.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.85
|
| Rate for Payer: United Healthcare VA CCN |
$302.85
|
|
|
US FETAL BIOPHY PROFIL W/O NST
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
9607681901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$651.29 |
| 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 |
$651.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$651.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.00
|
| 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: Multiplan Commercial |
$818.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.00
|
| Rate for Payer: United Healthcare Commercial |
$836.00
|
|
|
US guided breast biopsy LT
|
Professional
|
Both
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083LT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$1,608.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,608.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$968.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$968.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$259.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$740.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$740.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.62
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.60
|
| Rate for Payer: United Healthcare Commercial |
$217.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.60
|
| Rate for Payer: United Healthcare VA CCN |
$141.60
|
|
|
US guided breast biopsy LT
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083LT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$757.80 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,030.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,385.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.24
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.95
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare VA CCN |
$769.95
|
|
|
US guided breast biopsy LT
|
Facility
|
IP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
40219083LT
|
|
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 guided breast biopsy LT
|
Facility
|
IP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083LT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,266.31 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,368.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
|
|
US guided breast biopsy LT
|
Facility
|
OP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
40219083LT
|
|
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 guided breast biopsy RT
|
Facility
|
IP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
40219083RT
|
|
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 guided breast biopsy RT
|
Facility
|
OP
|
$2,376.10
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
40219083RT
|
|
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 guided breast biopsy RT
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083RT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$757.80 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,030.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,385.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.24
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.95
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare VA CCN |
$769.95
|
|
|
US guided breast biopsy RT
|
Facility
|
IP
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083RT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,266.31 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,368.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
|
|
US guided breast biopsy RT
|
Professional
|
Both
|
$1,711.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
97219083RT
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$1,608.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,608.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$968.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$968.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$259.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$740.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$740.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$458.62
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.60
|
| Rate for Payer: United Healthcare Commercial |
$217.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.60
|
| Rate for Payer: United Healthcare VA CCN |
$141.60
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9817693702
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
|
|
US GUIDE VASCULAR ACCESS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$106.73 |
| Rate for Payer: Aetna of VT Commercial |
$94.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.42
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$55.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.55
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$56.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare VA CCN |
$36.55
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$466.33
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
4027693701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.13 |
| Max. Negotiated Rate |
$443.01 |
| Rate for Payer: Aetna of VT Commercial |
$443.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$345.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$345.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.06
|
| Rate for Payer: Cash Price |
$233.16
|
| Rate for Payer: Cigna Commercial |
$373.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.06
|
| Rate for Payer: Multiplan Commercial |
$433.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.38
|
| Rate for Payer: United Healthcare Commercial |
$443.01
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$466.33
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
4027693701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$443.01 |
| Rate for Payer: Aetna of VT Commercial |
$443.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$370.73
|
| Rate for Payer: Cash Price |
$233.16
|
| Rate for Payer: Cash Price |
$233.16
|
| Rate for Payer: Cigna Commercial |
$373.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.85
|
| Rate for Payer: Multiplan Commercial |
$433.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.85
|
| Rate for Payer: United Healthcare Commercial |
$443.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.85
|
| Rate for Payer: United Healthcare VA CCN |
$209.85
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$376.91 |
| Max. Negotiated Rate |
$808.45 |
| Rate for Payer: Aetna of VT Commercial |
$808.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$762.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$376.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$762.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$512.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$723.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$689.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$382.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$676.54
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$680.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$680.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$680.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$382.95
|
| Rate for Payer: Multiplan Commercial |
$791.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$723.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$382.95
|
| Rate for Payer: United Healthcare Commercial |
$808.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.95
|
| Rate for Payer: United Healthcare VA CCN |
$382.95
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$512.86
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
4507693701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.15 |
| Max. Negotiated Rate |
$487.22 |
| Rate for Payer: Aetna of VT Commercial |
$487.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$227.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$415.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$230.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.72
|
| Rate for Payer: Cash Price |
$256.43
|
| Rate for Payer: Cigna Commercial |
$410.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$410.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$410.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$230.79
|
| Rate for Payer: Multiplan Commercial |
$476.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$230.79
|
| Rate for Payer: United Healthcare Commercial |
$487.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.79
|
| Rate for Payer: United Healthcare VA CCN |
$230.79
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
5107693701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$555.82 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna of VT Commercial |
$713.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$555.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$555.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$638.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.80
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$600.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.80
|
| Rate for Payer: Multiplan Commercial |
$698.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.35
|
| Rate for Payer: United Healthcare Commercial |
$713.45
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.50
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare VA CCN |
$45.00
|
|
|
US GUIDE VASCULAR ACCESS
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
5107693701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$705.94 |
| Rate for Payer: Aetna of VT Commercial |
$705.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.42
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$55.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.55
|
| Rate for Payer: Multiplan Commercial |
$698.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$56.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare VA CCN |
$36.55
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
|
|
US GUIDE VASCULAR ACCESS
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$799.94 |
| Rate for Payer: Aetna of VT Commercial |
$799.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.42
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$55.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.55
|
| Rate for Payer: Multiplan Commercial |
$791.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$56.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.55
|
| Rate for Payer: United Healthcare VA CCN |
$36.55
|
|
