|
US GUIDE VASCULAR ACCESS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9817693702
|
|
Hospital Revenue Code
|
981
|
| 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
|
$851.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9607693701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$629.83 |
| 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 |
$629.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$629.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$723.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$680.80
|
| 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: Multiplan Commercial |
$791.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$723.35
|
| Rate for Payer: United Healthcare Commercial |
$808.45
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
IP
|
$512.86
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
4507693701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.57 |
| 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 |
$379.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$379.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.29
|
| 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: Multiplan Commercial |
$476.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.93
|
| Rate for Payer: United Healthcare Commercial |
$487.22
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
5107693701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.62 |
| 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 |
$672.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$672.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$452.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$638.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$608.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$597.04
|
| 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: Martins Point Health Care Commercial |
$337.95
|
| Rate for Payer: Multiplan Commercial |
$698.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$638.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$337.95
|
| Rate for Payer: United Healthcare Commercial |
$713.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$337.95
|
| Rate for Payer: United Healthcare VA CCN |
$337.95
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
9817693702
|
|
Hospital Revenue Code
|
981
|
| 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 LMTD JT/FCL EVL NVASC XTR
|
Facility
|
IP
|
$648.32
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$479.82 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna of VT Commercial |
$615.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$479.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$479.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$544.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$518.66
|
| Rate for Payer: Cash Price |
$324.16
|
| Rate for Payer: Cigna Commercial |
$518.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.66
|
| Rate for Payer: Multiplan Commercial |
$602.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.07
|
| Rate for Payer: United Healthcare Commercial |
$615.90
|
|
|
US LMTD JT/FCL EVL NVASC XTR
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
9727688201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.64 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Aetna of VT Commercial |
$155.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.38
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$131.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.80
|
| Rate for Payer: Multiplan Commercial |
$152.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare Commercial |
$155.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.80
|
| Rate for Payer: United Healthcare VA CCN |
$73.80
|
|
|
US LMTD JT/FCL EVL NVASC XTR
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
9727688201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$121.38 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Aetna of VT Commercial |
$155.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.20
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$131.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.20
|
| Rate for Payer: Multiplan Commercial |
$152.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.40
|
| Rate for Payer: United Healthcare Commercial |
$155.80
|
|
|
US LMTD JT/FCL EVL NVASC XTR
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9727688201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$154.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$152.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
US LMTD JT/FCL EVL NVASC XTR
|
Facility
|
OP
|
$648.32
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.17 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna of VT Commercial |
$615.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$551.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$525.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$515.41
|
| Rate for Payer: Cash Price |
$324.16
|
| Rate for Payer: Cash Price |
$324.16
|
| Rate for Payer: Cigna Commercial |
$518.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$518.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$518.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.74
|
| Rate for Payer: Multiplan Commercial |
$602.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$551.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.74
|
| Rate for Payer: United Healthcare Commercial |
$615.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.74
|
| Rate for Payer: United Healthcare VA CCN |
$291.74
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$629.83 |
| 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 |
$629.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$629.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$723.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$680.80
|
| 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: Multiplan Commercial |
$791.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$723.35
|
| Rate for Payer: United Healthcare Commercial |
$808.45
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$217.91 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Aetna of VT Commercial |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$217.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.14
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.40
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.40
|
| Rate for Payer: United Healthcare VA CCN |
$221.40
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$462.48 |
| Rate for Payer: Aetna of VT Commercial |
$462.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.97
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$84.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.39
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare Commercial |
$86.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare VA CCN |
$56.39
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$364.13 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Aetna of VT Commercial |
$467.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$364.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$393.60
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$393.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$393.60
|
| Rate for Payer: Multiplan Commercial |
$457.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$418.20
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.39 |
| 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 |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.97
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$84.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.39
|
| Rate for Payer: Multiplan Commercial |
$791.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare Commercial |
$86.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare VA CCN |
$56.39
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
9607694201
|
|
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 NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5107694201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.44 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of VT Commercial |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$334.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$359.45
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
4027694201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.03 |
| Max. Negotiated Rate |
$341.48 |
| Rate for Payer: Aetna of VT Commercial |
$341.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$301.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.56
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cigna Commercial |
$287.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.56
|
| Rate for Payer: Multiplan Commercial |
$334.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.53
|
| Rate for Payer: United Healthcare Commercial |
$341.48
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5107694201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna of VT Commercial |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.97
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$84.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.39
|
| Rate for Payer: Multiplan Commercial |
$334.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare Commercial |
$86.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.39
|
| Rate for Payer: United Healthcare VA CCN |
$56.39
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5107694201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.44 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of VT Commercial |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$322.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.20
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$334.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.00
|
| Rate for Payer: United Healthcare VA CCN |
$162.00
|
|
|
US NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$359.45
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
4027694201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.61 |
| Max. Negotiated Rate |
$341.48 |
| Rate for Payer: Aetna of VT Commercial |
$341.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$216.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$305.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$285.76
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cash Price |
$179.72
|
| Rate for Payer: Cigna Commercial |
$287.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$287.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$287.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.75
|
| Rate for Payer: Multiplan Commercial |
$334.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.75
|
| Rate for Payer: United Healthcare Commercial |
$341.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.75
|
| Rate for Payer: United Healthcare VA CCN |
$161.75
|
|
|
US OB >= 14 WKS 1/1ST GESTAT
|
Facility
|
IP
|
$830.34
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
4027680501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$614.53 |
| Max. Negotiated Rate |
$788.82 |
| Rate for Payer: Aetna of VT Commercial |
$788.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$614.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$614.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$705.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$697.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$664.27
|
| Rate for Payer: Cash Price |
$415.17
|
| Rate for Payer: Cigna Commercial |
$664.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$664.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$664.27
|
| Rate for Payer: Multiplan Commercial |
$772.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.79
|
| Rate for Payer: United Healthcare Commercial |
$788.82
|
|
|
US OB >= 14 WKS 1/1ST GESTAT
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 76805 26
|
| Hospital Charge Code |
9727680501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.25
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.95
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare VA CCN |
$139.95
|
|
|
US OB >= 14 WKS 1/1ST GESTAT
|
Facility
|
OP
|
$830.34
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
4027680501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$367.76 |
| Max. Negotiated Rate |
$788.82 |
| Rate for Payer: Aetna of VT Commercial |
$788.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$367.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$499.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$705.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$672.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$373.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$660.12
|
| Rate for Payer: Cash Price |
$415.17
|
| Rate for Payer: Cash Price |
$415.17
|
| Rate for Payer: Cigna Commercial |
$664.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$664.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$664.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$373.65
|
| Rate for Payer: Multiplan Commercial |
$772.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$705.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.65
|
| Rate for Payer: United Healthcare Commercial |
$788.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.65
|
| Rate for Payer: United Healthcare VA CCN |
$373.65
|
|
|
US OB >= 14 WKS 1/1ST GESTAT
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 76805 26
|
| Hospital Charge Code |
9727680501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.80
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
|
