|
X-RAY EXAM SURGICAL SPECIMEN
|
Facility
|
IP
|
$626.60
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32076098LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.28
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
|
|
X-RAY EXAM SURGICAL SPECIMEN
|
Facility
|
OP
|
$626.60
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32076098LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$377.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$281.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.15
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$281.97
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare VA CCN |
$281.97
|
|
|
X-RAY EXAM SURGICAL SPECIMEN
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
9727609801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
X-RAY EXAM SURGICAL SPECIMEN
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727609801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
X-RAY EXAM SURGICAL SPECIMEN
|
Facility
|
IP
|
$626.60
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32076098RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$463.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$526.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$501.28
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
|
|
X-RAY EXAM SURGICAL SPECIMEN
|
Facility
|
OP
|
$626.60
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32076098RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.75 |
| Max. Negotiated Rate |
$595.27 |
| Rate for Payer: Aetna of VT Commercial |
$595.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$277.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$377.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$532.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$507.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$281.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$498.15
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cigna Commercial |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$281.97
|
| Rate for Payer: Multiplan Commercial |
$582.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$532.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare Commercial |
$595.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$281.97
|
| Rate for Payer: United Healthcare VA CCN |
$281.97
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
OP
|
$557.42
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: Aetna of VT Commercial |
$529.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$246.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$335.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$250.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$443.15
|
| Rate for Payer: Cash Price |
$278.71
|
| Rate for Payer: Cash Price |
$278.71
|
| Rate for Payer: Cigna Commercial |
$445.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$250.84
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$250.84
|
| Rate for Payer: United Healthcare Commercial |
$529.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.84
|
| Rate for Payer: United Healthcare VA CCN |
$250.84
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
9727208001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$106.73 |
| Rate for Payer: Aetna of VT Commercial |
$38.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.33
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.14
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.15
|
| Rate for Payer: United Healthcare Commercial |
$50.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.15
|
| Rate for Payer: United Healthcare VA CCN |
$33.15
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
IP
|
$557.42
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$412.55 |
| Max. Negotiated Rate |
$529.55 |
| Rate for Payer: Aetna of VT Commercial |
$529.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$468.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.94
|
| Rate for Payer: Cash Price |
$278.71
|
| Rate for Payer: Cigna Commercial |
$445.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.94
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.81
|
| Rate for Payer: United Healthcare Commercial |
$529.55
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
9727208001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.34 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Aetna of VT Commercial |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.80
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$32.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.85
|
| Rate for Payer: United Healthcare Commercial |
$38.95
|
|
|
X-RAY EXAM THORACOLMB 2/> VW
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
9727208001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Aetna of VT Commercial |
$38.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.59
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$32.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.45
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.45
|
| Rate for Payer: United Healthcare Commercial |
$38.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.45
|
| Rate for Payer: United Healthcare VA CCN |
$18.45
|
|
|
X-RAY EYE FOREIGN BODY- BILAT
|
Facility
|
IP
|
$485.98
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
3207003002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.67 |
| Max. Negotiated Rate |
$461.68 |
| Rate for Payer: Aetna of VT Commercial |
$461.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.78
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cigna Commercial |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.78
|
| Rate for Payer: Multiplan Commercial |
$451.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.08
|
| Rate for Payer: United Healthcare Commercial |
$461.68
|
|
|
X-RAY EYE FOREIGN BODY- BILAT
|
Facility
|
OP
|
$485.98
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
3207003002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$461.68 |
| Rate for Payer: Aetna of VT Commercial |
$461.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$215.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$292.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.35
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cigna Commercial |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.69
|
| Rate for Payer: Multiplan Commercial |
$451.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.69
|
| Rate for Payer: United Healthcare Commercial |
$461.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.69
|
| Rate for Payer: United Healthcare VA CCN |
$218.69
|
|
|
X-RAY FEMALE GENITAL TRACT
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
9727474001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna of VT Commercial |
$202.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.34
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.85
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.85
|
| Rate for Payer: United Healthcare Commercial |
$202.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.85
|
| Rate for Payer: United Healthcare VA CCN |
$95.85
|
|
|
X-RAY FEMALE GENITAL TRACT
|
Facility
|
OP
|
$1,027.80
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
3207474001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.79 |
| Max. Negotiated Rate |
$976.41 |
| Rate for Payer: Aetna of VT Commercial |
$976.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$455.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$618.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$832.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$462.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$817.10
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$822.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$462.51
|
| Rate for Payer: Multiplan Commercial |
$955.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$462.51
|
| Rate for Payer: United Healthcare Commercial |
$976.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$462.51
|
| Rate for Payer: United Healthcare VA CCN |
$462.51
|
|
|
X-RAY FEMALE GENITAL TRACT
|
Facility
|
IP
|
$1,027.80
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
3207474001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$760.67 |
| Max. Negotiated Rate |
$976.41 |
| Rate for Payer: Aetna of VT Commercial |
$976.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$760.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$760.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$873.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$822.24
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna Commercial |
$822.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$822.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$822.24
|
| Rate for Payer: Multiplan Commercial |
$955.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$873.63
|
| Rate for Payer: United Healthcare Commercial |
$976.41
|
|
|
X-RAY FEMALE GENITAL TRACT
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
9727474001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna of VT Commercial |
$202.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.40
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.05
|
| Rate for Payer: United Healthcare Commercial |
$202.35
|
|
|
X-RAY FEMALE GENITAL TRACT
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
9727474001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$200.22 |
| Rate for Payer: Aetna of VT Commercial |
$200.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.81
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$56.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$56.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
X-RAY NOSE TO RECTUM
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 76010 26
|
| Hospital Charge Code |
9727601001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna of VT Commercial |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.60
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
|
|
X-RAY NOSE TO RECTUM
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 76010 26
|
| Hospital Charge Code |
9727601001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna of VT Commercial |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.46
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare VA CCN |
$12.15
|
|
|
X-RAY NOSE TO RECTUM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
9727601001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$90.86 |
| Rate for Payer: Aetna of VT Commercial |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.32
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$45.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$45.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.99
|
| Rate for Payer: Multiplan Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.00
|
| Rate for Payer: United Healthcare VA CCN |
$28.00
|
|
|
X-RAY NOSE TO RECTUM
|
Facility
|
OP
|
$474.74
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
3207601001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$451.00 |
| Rate for Payer: Aetna of VT Commercial |
$451.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$210.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$285.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$384.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$213.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.42
|
| Rate for Payer: Cash Price |
$237.37
|
| Rate for Payer: Cash Price |
$237.37
|
| Rate for Payer: Cigna Commercial |
$379.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$213.63
|
| Rate for Payer: Multiplan Commercial |
$441.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.63
|
| Rate for Payer: United Healthcare Commercial |
$451.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.63
|
| Rate for Payer: United Healthcare VA CCN |
$213.63
|
|
|
X-RAY NOSE TO RECTUM
|
Facility
|
IP
|
$474.74
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
3207601001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.36 |
| Max. Negotiated Rate |
$451.00 |
| Rate for Payer: Aetna of VT Commercial |
$451.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$351.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$351.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$403.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$398.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.79
|
| Rate for Payer: Cash Price |
$237.37
|
| Rate for Payer: Cigna Commercial |
$379.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$379.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$379.79
|
| Rate for Payer: Multiplan Commercial |
$441.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$403.53
|
| Rate for Payer: United Healthcare Commercial |
$451.00
|
|
|
X-RAY SM INT F-THRU STD
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
9727424801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$215.08 |
| Rate for Payer: Aetna of VT Commercial |
$127.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.13
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$119.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.77
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.76
|
| Rate for Payer: United Healthcare Commercial |
$119.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.76
|
| Rate for Payer: United Healthcare VA CCN |
$77.76
|
|
|
X-RAY SM INT F-THRU STD
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
9727424801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.12
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare VA CCN |
$61.20
|
|
