|
US OB >= 14 WKS 1/1ST GESTAT
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 76805 26
|
| Hospital Charge Code |
9727680501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$385.40 |
| Rate for Payer: Aetna of VT Commercial |
$292.34
|
| 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 |
$46.25
|
| 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 |
$62.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.37
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$67.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.90
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.90
|
| Rate for Payer: United Healthcare Commercial |
$69.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.90
|
| Rate for Payer: United Healthcare VA CCN |
$44.90
|
|
|
US OB US < 14 WKS 1/1ST GESTAT
|
Facility
|
IP
|
$892.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
4027680101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$660.81 |
| Max. Negotiated Rate |
$848.22 |
| Rate for Payer: Aetna of VT Commercial |
$848.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$660.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$660.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$758.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.29
|
| Rate for Payer: Cash Price |
$446.43
|
| Rate for Payer: Cigna Commercial |
$714.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.29
|
| Rate for Payer: Multiplan Commercial |
$830.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$758.93
|
| Rate for Payer: United Healthcare Commercial |
$848.22
|
|
|
US OB US < 14 WKS 1/1ST GESTAT
|
Facility
|
OP
|
$892.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
4027680101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.56 |
| Max. Negotiated Rate |
$848.22 |
| Rate for Payer: Aetna of VT Commercial |
$848.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$395.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$537.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$758.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$723.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$401.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$709.82
|
| Rate for Payer: Cash Price |
$446.43
|
| Rate for Payer: Cash Price |
$446.43
|
| Rate for Payer: Cigna Commercial |
$714.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$714.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$714.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$401.79
|
| Rate for Payer: Multiplan Commercial |
$830.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$758.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$401.79
|
| Rate for Payer: United Healthcare Commercial |
$848.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.79
|
| Rate for Payer: United Healthcare VA CCN |
$401.79
|
|
|
US OB US < 14 WKS 1/1ST GESTAT
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 76801 26
|
| Hospital Charge Code |
9727680101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.79
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.90
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.90
|
| Rate for Payer: United Healthcare VA CCN |
$162.90
|
|
|
US OB US < 14 WKS 1/1ST GESTAT
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 76801 26
|
| Hospital Charge Code |
9727680101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$340.28 |
| Rate for Payer: Aetna of VT Commercial |
$340.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$307.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.37
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$67.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
|
US OB US < 14 WKS 1/1ST GESTAT
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 76801 26
|
| Hospital Charge Code |
9727680101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$267.92 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna of VT Commercial |
$343.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$307.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.60
|
| Rate for Payer: Cash Price |
$181.00
|
| Rate for Payer: Cigna Commercial |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.60
|
| Rate for Payer: Multiplan Commercial |
$336.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$307.70
|
| Rate for Payer: United Healthcare Commercial |
$343.90
|
|
|
US OB US <14 WKS ADDL FETUS
|
Facility
|
OP
|
$437.90
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
4027680201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.03 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna of VT Commercial |
$416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$354.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.13
|
| Rate for Payer: Cash Price |
$218.95
|
| Rate for Payer: Cash Price |
$218.95
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.06
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.06
|
| Rate for Payer: United Healthcare Commercial |
$416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.06
|
| Rate for Payer: United Healthcare VA CCN |
$197.06
|
|
|
US OB US <14 WKS ADDL FETUS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76802 26
|
| Hospital Charge Code |
9727680201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna of VT Commercial |
$206.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.88
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$56.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.31
|
| Rate for Payer: United Healthcare Commercial |
$57.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.31
|
| Rate for Payer: United Healthcare VA CCN |
$37.31
|
|
|
US OB US <14 WKS ADDL FETUS
|
Facility
|
IP
|
$437.90
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
4027680201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$324.09 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna of VT Commercial |
$416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$324.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$324.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$372.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.32
|
| Rate for Payer: Cash Price |
$218.95
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$350.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$350.32
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$372.21
|
| Rate for Payer: United Healthcare Commercial |
$416.00
|
|
|
US OB US <14 WKS ADDL FETUS
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 76802 26
|
| Hospital Charge Code |
9727680201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
US OB US <14 WKS ADDL FETUS
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 76802 26
|
| Hospital Charge Code |
9727680201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
US OB US >= 14 WKS ADDL FETUS
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 76810 26
|
| Hospital Charge Code |
9727681001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$250.15 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.40
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
|
|
US OB US >= 14 WKS ADDL FETUS
|
Facility
|
OP
|
$503.87
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
4027681001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$178.98 |
| Max. Negotiated Rate |
$478.68 |
| Rate for Payer: Aetna of VT Commercial |
$478.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$223.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$303.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$226.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.58
|
| Rate for Payer: Cash Price |
$251.94
|
| Rate for Payer: Cash Price |
$251.94
|
| Rate for Payer: Cigna Commercial |
$403.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.74
|
| Rate for Payer: Multiplan Commercial |
$468.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.74
|
| Rate for Payer: United Healthcare Commercial |
$478.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.74
|
| Rate for Payer: United Healthcare VA CCN |
$226.74
|
|
|
US OB US >= 14 WKS ADDL FETUS
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 76810 26
|
| Hospital Charge Code |
9727681001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna of VT Commercial |
$321.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$302.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.71
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.10
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.10
|
| Rate for Payer: United Healthcare VA CCN |
$152.10
|
|
|
US OB US >= 14 WKS ADDL FETUS
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
CPT 76810 26
|
| Hospital Charge Code |
9727681001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Aetna of VT Commercial |
$317.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.84
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.24
|
| Rate for Payer: Multiplan Commercial |
$314.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.24
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.24
|
| Rate for Payer: United Healthcare VA CCN |
$44.24
|
|
|
US OB US >= 14 WKS ADDL FETUS
|
Facility
|
IP
|
$503.87
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
4027681001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$372.91 |
| Max. Negotiated Rate |
$478.68 |
| Rate for Payer: Aetna of VT Commercial |
$478.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.10
|
| Rate for Payer: Cash Price |
$251.94
|
| Rate for Payer: Cigna Commercial |
$403.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.10
|
| Rate for Payer: Multiplan Commercial |
$468.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.29
|
| Rate for Payer: United Healthcare Commercial |
$478.68
|
|
|
US OB US FOLLOW UP PER FETUS
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 76816 26
|
| Hospital Charge Code |
9727681601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$303.25 |
| Rate for Payer: Aetna of VT Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$303.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$303.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.61
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$58.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.43
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.43
|
| Rate for Payer: United Healthcare Commercial |
$59.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.43
|
| Rate for Payer: United Healthcare VA CCN |
$38.43
|
|
|
US OB US FOLLOW UP PER FETUS
|
Facility
|
OP
|
$779.64
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
4027681601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.25 |
| Max. Negotiated Rate |
$740.66 |
| Rate for Payer: Aetna of VT Commercial |
$740.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$303.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$345.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$303.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$469.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$631.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$619.81
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cigna Commercial |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$350.84
|
| Rate for Payer: Multiplan Commercial |
$725.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$350.84
|
| Rate for Payer: United Healthcare Commercial |
$740.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.84
|
| Rate for Payer: United Healthcare VA CCN |
$350.84
|
|
|
US OB US FOLLOW UP PER FETUS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 76816 26
|
| Hospital Charge Code |
9727681601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
US OB US FOLLOW UP PER FETUS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 76816 26
|
| Hospital Charge Code |
9727681601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
US OB US FOLLOW UP PER FETUS
|
Facility
|
IP
|
$779.64
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
4027681601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$577.01 |
| Max. Negotiated Rate |
$740.66 |
| Rate for Payer: Aetna of VT Commercial |
$740.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$662.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$654.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$623.71
|
| Rate for Payer: Cash Price |
$389.82
|
| Rate for Payer: Cigna Commercial |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$623.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$623.71
|
| Rate for Payer: Multiplan Commercial |
$725.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.69
|
| Rate for Payer: United Healthcare Commercial |
$740.66
|
|
|
US OB US LIMITED 1/> FETUSES
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 76815 26
|
| Hospital Charge Code |
9727681501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$478.46 |
| Rate for Payer: Aetna of VT Commercial |
$478.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$49.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.72
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$43.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.24
|
| Rate for Payer: Multiplan Commercial |
$473.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.24
|
| Rate for Payer: United Healthcare Commercial |
$44.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.24
|
| Rate for Payer: United Healthcare VA CCN |
$29.24
|
|
|
US OB US LIMITED 1/> FETUSES
|
Facility
|
IP
|
$562.75
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
4027681501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.49 |
| Max. Negotiated Rate |
$534.61 |
| Rate for Payer: Aetna of VT Commercial |
$534.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$472.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$450.20
|
| Rate for Payer: Cash Price |
$281.38
|
| Rate for Payer: Cigna Commercial |
$450.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.20
|
| Rate for Payer: Multiplan Commercial |
$523.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.34
|
| Rate for Payer: United Healthcare Commercial |
$534.61
|
|
|
US OB US LIMITED 1/> FETUSES
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 76815 26
|
| Hospital Charge Code |
9727681501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$225.44 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna of VT Commercial |
$483.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$456.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$225.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$456.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$306.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$412.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$229.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$404.65
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$229.05
|
| Rate for Payer: Multiplan Commercial |
$473.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$229.05
|
| Rate for Payer: United Healthcare Commercial |
$483.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.05
|
| Rate for Payer: United Healthcare VA CCN |
$229.05
|
|
|
US OB US LIMITED 1/> FETUSES
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 76815 26
|
| Hospital Charge Code |
9727681501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$376.71 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna of VT Commercial |
$483.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$432.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$427.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.20
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$407.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$407.20
|
| Rate for Payer: Multiplan Commercial |
$473.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.65
|
| Rate for Payer: United Healthcare Commercial |
$483.55
|
|
