|
US TRANSRECTAL
|
Facility
|
IP
|
$1,346.40
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
4027687201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$996.47 |
| Max. Negotiated Rate |
$1,279.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,279.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$996.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$996.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,144.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,130.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,077.12
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$1,077.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,077.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,077.12
|
| Rate for Payer: Multiplan Commercial |
$1,252.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,144.44
|
| Rate for Payer: United Healthcare Commercial |
$1,279.08
|
|
|
US TRANSRECTAL
|
Facility
|
OP
|
$411.40
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
9727687201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$182.21 |
| 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 |
$368.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$327.06
|
| 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: Martins Point Health Care Commercial |
$185.13
|
| Rate for Payer: Multiplan Commercial |
$382.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.13
|
| Rate for Payer: United Healthcare Commercial |
$390.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.13
|
| Rate for Payer: United Healthcare VA CCN |
$185.13
|
|
|
US TRANSRECTAL
|
Professional
|
Both
|
$411.40
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
9727687201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$135.89 |
| Max. Negotiated Rate |
$462.17 |
| Rate for Payer: Aetna of VT Commercial |
$386.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$253.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$253.58
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cigna Commercial |
$293.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$302.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$302.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.89
|
| Rate for Payer: Multiplan Commercial |
$382.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$268.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.73
|
| Rate for Payer: United Healthcare Commercial |
$290.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.73
|
| Rate for Payer: United Healthcare VA CCN |
$188.73
|
|
|
US TRANSRECTAL
|
Facility
|
OP
|
$1,346.40
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
4027687201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$462.17 |
| Max. Negotiated Rate |
$1,279.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,279.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$596.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$810.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,144.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,090.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$605.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,070.39
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$1,077.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,077.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,077.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$605.88
|
| Rate for Payer: Multiplan Commercial |
$1,252.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,144.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$605.88
|
| Rate for Payer: United Healthcare Commercial |
$1,279.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$605.88
|
| Rate for Payer: United Healthcare VA CCN |
$605.88
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683002
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
US TRANSVAGINAL
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
5107683001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$399.05 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna of VT Commercial |
$855.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$807.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$399.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$807.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$405.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$716.29
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$405.45
|
| Rate for Payer: Multiplan Commercial |
$837.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.45
|
| Rate for Payer: United Healthcare Commercial |
$855.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.45
|
| Rate for Payer: United Healthcare VA CCN |
$405.45
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$896.26 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,017.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
|
|
US TRANSVAGINAL
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$376.73 |
| Rate for Payer: Aetna of VT Commercial |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.12
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$173.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.77
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare Commercial |
$173.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare VA CCN |
$112.77
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
5107683001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$666.83 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna of VT Commercial |
$855.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$666.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$666.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$756.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.80
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.80
|
| Rate for Payer: Multiplan Commercial |
$837.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.85
|
| Rate for Payer: United Healthcare Commercial |
$855.95
|
|
|
US TRANSVAGINAL
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683002
|
|
Hospital Revenue Code
|
960
|
| 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 TRANSVAGINAL
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$729.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$980.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$962.75
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.95
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare VA CCN |
$544.95
|
|
|
US TRANSVAGINAL
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
9607683001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.12
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$173.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.77
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare Commercial |
$173.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare VA CCN |
$112.77
|
|
|
US TRANSVAGINAL
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
5107683001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$846.94 |
| Rate for Payer: Aetna of VT Commercial |
$846.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.12
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cash Price |
$450.50
|
| Rate for Payer: Cigna Commercial |
$173.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.77
|
| Rate for Payer: Multiplan Commercial |
$837.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare Commercial |
$173.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.77
|
| Rate for Payer: United Healthcare VA CCN |
$112.77
|
|
|
US TRANSVAGINAL NON-OB
|
Facility
|
IP
|
$900.61
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$666.54 |
| Max. Negotiated Rate |
$855.58 |
| Rate for Payer: Aetna of VT Commercial |
$855.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$666.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$666.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$756.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$720.49
|
| Rate for Payer: Cash Price |
$450.30
|
| Rate for Payer: Cigna Commercial |
$720.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.49
|
| Rate for Payer: Multiplan Commercial |
$837.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.52
|
| Rate for Payer: United Healthcare Commercial |
$855.58
|
|
|
US TRANSVAGINAL NON-OB
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 76830 26
|
| Hospital Charge Code |
9727683001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$376.73 |
| Rate for Payer: Aetna of VT Commercial |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.02
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$46.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.17
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.17
|
| Rate for Payer: United Healthcare Commercial |
$47.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.17
|
| Rate for Payer: United Healthcare VA CCN |
$31.17
|
|
|
US TRANSVAGINAL NON-OB
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 76830 26
|
| Hospital Charge Code |
9727683001
|
|
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 TRANSVAGINAL NON-OB
|
Facility
|
OP
|
$900.61
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$376.73 |
| Max. Negotiated Rate |
$855.58 |
| Rate for Payer: Aetna of VT Commercial |
$855.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$398.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$542.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$765.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$729.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$405.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$715.98
|
| Rate for Payer: Cash Price |
$450.30
|
| Rate for Payer: Cash Price |
$450.30
|
| Rate for Payer: Cigna Commercial |
$720.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$405.27
|
| Rate for Payer: Multiplan Commercial |
$837.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$855.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.27
|
| Rate for Payer: United Healthcare VA CCN |
$405.27
|
|
|
US TRANSVAGINAL NON-OB
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 76830 26
|
| Hospital Charge Code |
9727683001
|
|
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
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9825179801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9815179802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179802
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
4505179801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.27 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: Aetna of VT Commercial |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.42
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna Commercial |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.42
|
| Rate for Payer: Multiplan Commercial |
$64.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.89
|
| Rate for Payer: United Healthcare Commercial |
$65.82
|
|
|
US URINE CAPACITY MEASURE
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Aetna of VT Commercial |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.27
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$18.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.93
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.93
|
| Rate for Payer: United Healthcare VA CCN |
$10.93
|
|
|
US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
9605179801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.20
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
|
