|
CARPAL TUNNEL SURGERY
|
Professional
|
Both
|
$4,886.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
9606472101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$419.21 |
| Max. Negotiated Rate |
$4,592.84 |
| Rate for Payer: Aetna of VT Commercial |
$4,592.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,377.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$431.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,377.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$586.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,079.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,079.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$482.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,079.24
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: Cash Price |
$2,443.00
|
| Rate for Payer: Cigna Commercial |
$582.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$426.60
|
| Rate for Payer: Multiplan Commercial |
$4,543.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$595.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$419.21
|
| Rate for Payer: United Healthcare Commercial |
$644.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$419.21
|
| Rate for Payer: United Healthcare VA CCN |
$419.21
|
|
|
CARPAL TUNNEL SURGERY
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
9606472102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,100.53 |
| Max. Negotiated Rate |
$1,412.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,412.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,100.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,100.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,263.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,249.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,189.60
|
| Rate for Payer: Cash Price |
$743.50
|
| Rate for Payer: Cigna Commercial |
$1,189.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,189.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,189.60
|
| Rate for Payer: Multiplan Commercial |
$1,382.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,263.95
|
| Rate for Payer: United Healthcare Commercial |
$1,412.65
|
|
|
CARS/BD TST INFT-12MO +30MIN
|
Facility
|
IP
|
$31.85
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
4609478101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$30.26 |
| Rate for Payer: Aetna of VT Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.48
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cigna Commercial |
$25.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.48
|
| Rate for Payer: Multiplan Commercial |
$29.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.07
|
| Rate for Payer: United Healthcare Commercial |
$30.26
|
|
|
CARS/BD TST INFT-12MO +30MIN
|
Facility
|
OP
|
$31.85
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
4609478101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$30.26 |
| Rate for Payer: Aetna of VT Commercial |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.32
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cigna Commercial |
$25.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.33
|
| Rate for Payer: Multiplan Commercial |
$29.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.33
|
| Rate for Payer: United Healthcare Commercial |
$30.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.33
|
| Rate for Payer: United Healthcare VA CCN |
$14.33
|
|
|
CARS/BD TST INFT-12MO 60 MIN
|
Facility
|
IP
|
$64.83
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
4609478001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$61.59 |
| Rate for Payer: Aetna of VT Commercial |
$61.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.86
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cigna Commercial |
$51.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.86
|
| Rate for Payer: Multiplan Commercial |
$60.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.11
|
| Rate for Payer: United Healthcare Commercial |
$61.59
|
|
|
CARS/BD TST INFT-12MO 60 MIN
|
Facility
|
OP
|
$64.83
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
4609478001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$61.59 |
| Rate for Payer: Aetna of VT Commercial |
$61.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.54
|
| Rate for Payer: Cash Price |
$32.42
|
| Rate for Payer: Cigna Commercial |
$51.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.17
|
| Rate for Payer: Multiplan Commercial |
$60.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.17
|
| Rate for Payer: United Healthcare Commercial |
$61.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.17
|
| Rate for Payer: United Healthcare VA CCN |
$29.17
|
|
|
CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
982G010401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$521.29 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,118.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,054.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$521.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,054.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$708.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,000.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$953.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$529.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$935.72
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cigna Commercial |
$941.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$941.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$941.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$529.65
|
| Rate for Payer: Multiplan Commercial |
$1,094.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,000.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$529.65
|
| Rate for Payer: United Healthcare Commercial |
$1,118.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.65
|
| Rate for Payer: United Healthcare VA CCN |
$529.65
|
|
|
CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
982G010401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,118.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$871.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$871.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,000.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$988.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$941.60
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cigna Commercial |
$941.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$941.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$941.60
|
| Rate for Payer: Multiplan Commercial |
$1,094.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,000.45
|
| Rate for Payer: United Healthcare Commercial |
$1,118.15
|
|
|
CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
982G010401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$1,106.38 |
| Rate for Payer: Aetna of VT Commercial |
$1,106.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,054.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,054.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$234.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.02
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Cash Price |
$588.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$285.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$285.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$176.94
|
| Rate for Payer: Multiplan Commercial |
$1,094.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.95
|
| Rate for Payer: United Healthcare Commercial |
$81.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.95
|
| Rate for Payer: United Healthcare VA CCN |
$52.95
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$47.40
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
960G010102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna of VT Commercial |
$45.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.68
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$37.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.33
|
| Rate for Payer: Multiplan Commercial |
$44.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.33
|
| Rate for Payer: United Healthcare Commercial |
$45.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.33
|
| Rate for Payer: United Healthcare VA CCN |
$21.33
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$30.02 |
| Rate for Payer: Aetna of VT Commercial |
$30.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.28
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cigna Commercial |
$25.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.86
|
| Rate for Payer: United Healthcare Commercial |
$30.02
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$49.63
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
770G010101
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$47.15 |
| Rate for Payer: Aetna of VT Commercial |
$47.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.70
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna Commercial |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.70
|
| Rate for Payer: Multiplan Commercial |
$46.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.19
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$47.40
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
960G010102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna of VT Commercial |
$44.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.43
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$44.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$38.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare VA CCN |
$25.20
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$30.02 |
| Rate for Payer: Aetna of VT Commercial |
$30.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.12
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cigna Commercial |
$25.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.22
|
| Rate for Payer: Multiplan Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.22
|
| Rate for Payer: United Healthcare Commercial |
$30.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.22
|
| Rate for Payer: United Healthcare VA CCN |
$14.22
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$31.60
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
510G010101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna of VT Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.43
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$29.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$38.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare VA CCN |
$25.20
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$47.40
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
960G010102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna of VT Commercial |
$45.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.92
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$37.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.92
|
| Rate for Payer: Multiplan Commercial |
$44.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.29
|
| Rate for Payer: United Healthcare Commercial |
$45.03
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$49.63
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
770G010101
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$47.15 |
| Rate for Payer: Aetna of VT Commercial |
$47.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.46
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna Commercial |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.33
|
| Rate for Payer: Multiplan Commercial |
$46.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.33
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.33
|
| Rate for Payer: United Healthcare VA CCN |
$22.33
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
960G010101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.20
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
960G010101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$74.26 |
| Rate for Payer: Aetna of VT Commercial |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.43
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$38.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare VA CCN |
$25.20
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
960G010101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.80
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare VA CCN |
$35.55
|
|
|
CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$49.63
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
770G010101
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$60.18 |
| Rate for Payer: Aetna of VT Commercial |
$46.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.43
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$46.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Commercial |
$38.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare VA CCN |
$25.20
|
|
|
CAST PLASTER 2
|
Facility
|
OP
|
$3.80
|
|
| Hospital Charge Code |
2700016371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Aetna of VT Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.02
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna Commercial |
$3.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$3.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.71
|
| Rate for Payer: United Healthcare VA CCN |
$1.71
|
|
|
CAST PLASTER 2
|
Facility
|
IP
|
$3.80
|
|
| Hospital Charge Code |
2700016371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Aetna of VT Commercial |
$3.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3.04
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cigna Commercial |
$3.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$3.61
|
|
|
CAST PLASTER 3" X 3 YD
|
Facility
|
OP
|
$0.99
|
|
| Hospital Charge Code |
2700016381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.79
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
CAST PLASTER 3" X 3 YD
|
Facility
|
IP
|
$0.99
|
|
| Hospital Charge Code |
2700016381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.79
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$0.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
|
