|
US PRQ BRST LOC DEV EA ADD LES
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 19286 26
|
| Hospital Charge Code |
9721928601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$743.80 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Aetna of VT Commercial |
$954.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$743.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$743.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$854.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$844.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$804.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$804.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$804.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$804.00
|
| Rate for Payer: Multiplan Commercial |
$934.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$854.25
|
| Rate for Payer: United Healthcare Commercial |
$954.75
|
|
|
US PRQ BRST LOC DEV EA ADD LES
|
Facility
|
IP
|
$316.20
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4021928601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.02 |
| Max. Negotiated Rate |
$300.39 |
| Rate for Payer: Aetna of VT Commercial |
$300.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$268.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.96
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cigna Commercial |
$252.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.96
|
| Rate for Payer: Multiplan Commercial |
$294.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.77
|
| Rate for Payer: United Healthcare Commercial |
$300.39
|
|
|
US RETROPERITONEAL COMPLETE
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
9727677001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$621.34 |
| Rate for Payer: Aetna of VT Commercial |
$621.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.88
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cigna Commercial |
$50.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.96
|
| Rate for Payer: Multiplan Commercial |
$614.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$50.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.96
|
| Rate for Payer: United Healthcare VA CCN |
$32.96
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$847.88
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
4027677001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$627.52 |
| Max. Negotiated Rate |
$805.49 |
| Rate for Payer: Aetna of VT Commercial |
$805.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$627.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$627.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$712.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$678.30
|
| Rate for Payer: Cash Price |
$423.94
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$678.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$678.30
|
| Rate for Payer: Multiplan Commercial |
$788.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$720.70
|
| Rate for Payer: United Healthcare Commercial |
$805.49
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$847.88
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
4027677001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.12 |
| Max. Negotiated Rate |
$805.49 |
| Rate for Payer: Aetna of VT Commercial |
$805.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$375.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$510.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$720.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$686.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$381.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$674.06
|
| Rate for Payer: Cash Price |
$423.94
|
| Rate for Payer: Cash Price |
$423.94
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$678.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$678.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.55
|
| Rate for Payer: Multiplan Commercial |
$788.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$720.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.55
|
| Rate for Payer: United Healthcare Commercial |
$805.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Healthcare VA CCN |
$381.55
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
9727677001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$292.76 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Aetna of VT Commercial |
$627.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$292.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$397.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$535.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$297.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$525.50
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cigna Commercial |
$528.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$528.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$528.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$297.45
|
| Rate for Payer: Multiplan Commercial |
$614.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.45
|
| Rate for Payer: United Healthcare Commercial |
$627.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.45
|
| Rate for Payer: United Healthcare VA CCN |
$297.45
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
9727677001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$489.21 |
| Max. Negotiated Rate |
$627.95 |
| Rate for Payer: Aetna of VT Commercial |
$627.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$489.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$489.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$561.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$555.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.80
|
| Rate for Payer: Cash Price |
$330.50
|
| Rate for Payer: Cigna Commercial |
$528.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$528.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$528.80
|
| Rate for Payer: Multiplan Commercial |
$614.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$561.85
|
| Rate for Payer: United Healthcare Commercial |
$627.95
|
|
|
US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$779.64
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
4027677002
|
|
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 RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$779.64
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
4027677002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.12 |
| 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 |
$319.12
|
| 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 |
$319.12
|
| 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 RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 76775 26
|
| Hospital Charge Code |
9727677501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Aetna of VT Commercial |
$228.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.80
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$192.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.80
|
| Rate for Payer: Multiplan Commercial |
$224.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.85
|
| Rate for Payer: United Healthcare Commercial |
$228.95
|
|
|
US RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$621.43
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
4027677501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.42 |
| Max. Negotiated Rate |
$590.36 |
| Rate for Payer: Aetna of VT Commercial |
$590.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$275.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$279.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$494.04
|
| Rate for Payer: Cash Price |
$310.71
|
| Rate for Payer: Cash Price |
$310.71
|
| Rate for Payer: Cigna Commercial |
$497.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$497.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$497.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$279.64
|
| Rate for Payer: Multiplan Commercial |
$577.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.64
|
| Rate for Payer: United Healthcare Commercial |
$590.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.64
|
| Rate for Payer: United Healthcare VA CCN |
$279.64
|
|
|
US RETROPERITONEAL LIMITED
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 76775 26
|
| Hospital Charge Code |
9727677501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$226.54 |
| Rate for Payer: Aetna of VT Commercial |
$226.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.08
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$39.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$224.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.01
|
| Rate for Payer: United Healthcare Commercial |
$40.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.01
|
| Rate for Payer: United Healthcare VA CCN |
$26.01
|
|
|
US RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$621.43
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
4027677501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$459.92 |
| Max. Negotiated Rate |
$590.36 |
| Rate for Payer: Aetna of VT Commercial |
$590.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$497.14
|
| Rate for Payer: Cash Price |
$310.71
|
| Rate for Payer: Cigna Commercial |
$497.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$497.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$497.14
|
| Rate for Payer: Multiplan Commercial |
$577.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.22
|
| Rate for Payer: United Healthcare Commercial |
$590.36
|
|
|
US RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 76775 26
|
| Hospital Charge Code |
9727677501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Aetna of VT Commercial |
$228.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.59
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$192.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.45
|
| Rate for Payer: Multiplan Commercial |
$224.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.45
|
| Rate for Payer: United Healthcare Commercial |
$228.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.45
|
| Rate for Payer: United Healthcare VA CCN |
$108.45
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
IP
|
$1,009.44
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$747.09 |
| Max. Negotiated Rate |
$958.97 |
| Rate for Payer: Aetna of VT Commercial |
$958.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$747.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$747.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$858.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$847.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$807.55
|
| Rate for Payer: Cash Price |
$504.72
|
| Rate for Payer: Cigna Commercial |
$807.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$807.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$807.55
|
| Rate for Payer: Multiplan Commercial |
$938.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$858.02
|
| Rate for Payer: United Healthcare Commercial |
$958.97
|
|
|
US SCROTUM & CONTENTS
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 76870 26
|
| Hospital Charge Code |
9727687001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$304.66 |
| Rate for Payer: Aetna of VT Commercial |
$263.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.58
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$42.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.59
|
| Rate for Payer: United Healthcare Commercial |
$43.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.59
|
| Rate for Payer: United Healthcare VA CCN |
$28.59
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
OP
|
$1,009.44
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.66 |
| Max. Negotiated Rate |
$958.97 |
| Rate for Payer: Aetna of VT Commercial |
$958.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$447.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$607.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$858.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$817.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$454.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$802.50
|
| Rate for Payer: Cash Price |
$504.72
|
| Rate for Payer: Cash Price |
$504.72
|
| Rate for Payer: Cigna Commercial |
$807.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$807.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$807.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$454.25
|
| Rate for Payer: Multiplan Commercial |
$938.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$858.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$454.25
|
| Rate for Payer: United Healthcare Commercial |
$958.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.25
|
| Rate for Payer: United Healthcare VA CCN |
$454.25
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 76870 26
|
| Hospital Charge Code |
9727687001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$124.01 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$124.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.00
|
| Rate for Payer: United Healthcare VA CCN |
$126.00
|
|
|
US SCROTUM & CONTENTS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 76870 26
|
| Hospital Charge Code |
9727687001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$207.23 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna of VT Commercial |
$266.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$224.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$224.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$260.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$266.00
|
|
|
US SOFT TISSUE HEAD & NECK
|
Facility
|
OP
|
$880.97
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
4027653601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.93 |
| Max. Negotiated Rate |
$836.92 |
| Rate for Payer: Aetna of VT Commercial |
$836.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$363.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$390.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$363.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$530.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$713.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$396.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$700.37
|
| Rate for Payer: Cash Price |
$440.48
|
| Rate for Payer: Cash Price |
$440.48
|
| Rate for Payer: Cigna Commercial |
$704.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$396.44
|
| Rate for Payer: Multiplan Commercial |
$819.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.44
|
| Rate for Payer: United Healthcare Commercial |
$836.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.44
|
| Rate for Payer: United Healthcare VA CCN |
$396.44
|
|
|
US SOFT TISSUE HEAD & NECK
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
9727653601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.53
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare VA CCN |
$132.75
|
|
|
US SOFT TISSUE HEAD & NECK
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
9727653601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
|
|
US SOFT TISSUE HEAD & NECK
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
9727653601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$363.93 |
| Rate for Payer: Aetna of VT Commercial |
$277.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$363.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$363.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.71
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$38.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.36
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$39.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.36
|
| Rate for Payer: United Healthcare VA CCN |
$25.36
|
|
|
US SOFT TISSUE HEAD & NECK
|
Facility
|
IP
|
$880.97
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
4027653601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$652.01 |
| Max. Negotiated Rate |
$836.92 |
| Rate for Payer: Aetna of VT Commercial |
$836.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$652.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$652.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$748.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$740.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$704.78
|
| Rate for Payer: Cash Price |
$440.48
|
| Rate for Payer: Cigna Commercial |
$704.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$704.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$704.78
|
| Rate for Payer: Multiplan Commercial |
$819.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$748.82
|
| Rate for Payer: United Healthcare Commercial |
$836.92
|
|
|
US TRANSRECTAL
|
Facility
|
IP
|
$411.40
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
9727687201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$304.48 |
| Max. Negotiated Rate |
$390.83 |
| Rate for Payer: Aetna of VT Commercial |
$390.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.12
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cigna Commercial |
$329.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$329.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$329.12
|
| Rate for Payer: Multiplan Commercial |
$382.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.69
|
| Rate for Payer: United Healthcare Commercial |
$390.83
|
|
