|
BREAST REDUCTION
|
Professional
|
Both
|
$4,065.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
9821931801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,022.47 |
| Max. Negotiated Rate |
$3,821.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,821.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,641.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,053.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,641.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,431.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,095.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,095.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,175.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,095.51
|
| Rate for Payer: Cash Price |
$2,032.50
|
| Rate for Payer: Cash Price |
$2,032.50
|
| Rate for Payer: Cigna Commercial |
$1,863.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,704.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,704.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,022.47
|
| Rate for Payer: Multiplan Commercial |
$3,780.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,451.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,022.47
|
| Rate for Payer: United Healthcare Commercial |
$1,572.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,022.47
|
| Rate for Payer: United Healthcare VA CCN |
$1,022.47
|
|
|
BREAST REDUCTION
|
Facility
|
IP
|
$4,065.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
9821931801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$3,008.51 |
| Max. Negotiated Rate |
$3,861.75 |
| Rate for Payer: Aetna of VT Commercial |
$3,861.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,008.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,008.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,455.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,414.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,252.00
|
| Rate for Payer: Cash Price |
$2,032.50
|
| Rate for Payer: Cigna Commercial |
$3,252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,252.00
|
| Rate for Payer: Multiplan Commercial |
$3,780.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,455.25
|
| Rate for Payer: United Healthcare Commercial |
$3,861.75
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
9821931801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,800.39 |
| Max. Negotiated Rate |
$3,861.75 |
| Rate for Payer: Aetna of VT Commercial |
$3,861.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,641.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,800.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,641.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,447.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,455.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,292.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,829.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,231.68
|
| Rate for Payer: Cash Price |
$2,032.50
|
| Rate for Payer: Cigna Commercial |
$3,252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,252.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,829.25
|
| Rate for Payer: Multiplan Commercial |
$3,780.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,455.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,829.25
|
| Rate for Payer: United Healthcare Commercial |
$3,861.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,829.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,829.25
|
|
|
BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
9727706201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.40
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
|
|
BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$202.66
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
4017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$149.99 |
| Max. Negotiated Rate |
$192.53 |
| Rate for Payer: Aetna of VT Commercial |
$192.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.13
|
| Rate for Payer: Cash Price |
$101.33
|
| Rate for Payer: Cigna Commercial |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.13
|
| Rate for Payer: Multiplan Commercial |
$188.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.26
|
| Rate for Payer: United Healthcare Commercial |
$192.53
|
|
|
BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
9727706201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna of VT Commercial |
$416.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$392.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.21
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare Commercial |
$416.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.10
|
| Rate for Payer: United Healthcare VA CCN |
$197.10
|
|
|
BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727706201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$411.72 |
| Rate for Payer: Aetna of VT Commercial |
$411.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.10
|
| 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 |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$407.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$202.66
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
4017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$759.74 |
| Rate for Payer: Aetna of VT Commercial |
$192.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$759.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$759.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.11
|
| Rate for Payer: Cash Price |
$101.33
|
| Rate for Payer: Cash Price |
$101.33
|
| Rate for Payer: Cigna Commercial |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.13
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$188.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.20
|
| Rate for Payer: United Healthcare Commercial |
$192.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.20
|
| Rate for Payer: United Healthcare VA CCN |
$91.20
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
IP
|
$159.24
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
40177061RT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.39
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
IP
|
$159.24
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
40177061LT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.39
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727706101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$316.78 |
| Rate for Payer: Aetna of VT Commercial |
$316.78
|
| 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 |
$38.10
|
| 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 |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 77061 26
|
| Hospital Charge Code |
9727706101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.92
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.65
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.65
|
| Rate for Payer: United Healthcare VA CCN |
$151.65
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 77061 26
|
| Hospital Charge Code |
9727706101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna of VT Commercial |
$320.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$286.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.60
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.60
|
| Rate for Payer: Multiplan Commercial |
$313.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$320.15
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
OP
|
$159.24
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
40177061LT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$600.35 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$600.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$600.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.60
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare VA CCN |
$71.66
|
|
|
BREAST TOMOSYNTHESIS UNI
|
Facility
|
OP
|
$159.24
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
40177061RT
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$600.35 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$600.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$600.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.60
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare VA CCN |
$71.66
|
|
|
BREATHING BAG 3L
|
Facility
|
OP
|
$1.68
|
|
| Hospital Charge Code |
2700075451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of VT Commercial |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.34
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.76
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$1.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.76
|
| Rate for Payer: United Healthcare VA CCN |
$0.76
|
|
|
BREATHING BAG 3L
|
Facility
|
IP
|
$1.68
|
|
| Hospital Charge Code |
2700075451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna of VT Commercial |
$1.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.34
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$1.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$1.60
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9609401001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.60
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.45
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare VA CCN |
$198.45
|
|
|
BREATHING CAPACITY TEST
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9609401002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$78.02 |
| Rate for Payer: Aetna of VT Commercial |
$78.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.60
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$39.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.07
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$40.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare VA CCN |
$26.07
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9609401002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna of VT Commercial |
$78.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.98
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.35
|
| Rate for Payer: Multiplan Commercial |
$77.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.35
|
| Rate for Payer: United Healthcare VA CCN |
$37.35
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9769401001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.23
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.85
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.85
|
| Rate for Payer: United Healthcare VA CCN |
$14.85
|
|
|
BREATHING CAPACITY TEST
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9769401001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of VT Commercial |
$31.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.60
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$39.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.07
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$40.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare VA CCN |
$26.07
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
5109401001
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
9769401001
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.40
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$30.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.05
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
|
|
BREATHING CAPACITY TEST
|
Facility
|
OP
|
$358.21
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$340.30 |
| Rate for Payer: Aetna of VT Commercial |
$340.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.78
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$286.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.19
|
| Rate for Payer: Multiplan Commercial |
$333.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.19
|
| Rate for Payer: United Healthcare Commercial |
$340.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.19
|
| Rate for Payer: United Healthcare VA CCN |
$161.19
|
|
