|
CRYOPRECIPITATE EACH UNIT
|
Facility
|
OP
|
$192.83
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$183.19 |
| Rate for Payer: Aetna of VT Commercial |
$183.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.30
|
| Rate for Payer: Cash Price |
$96.42
|
| Rate for Payer: Cigna Commercial |
$154.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.77
|
| Rate for Payer: Multiplan Commercial |
$179.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.77
|
| Rate for Payer: United Healthcare Commercial |
$183.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.77
|
| Rate for Payer: United Healthcare VA CCN |
$86.77
|
|
|
CRYOPRECIPITATE EACH UNIT
|
Facility
|
IP
|
$192.83
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
390P901201
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$183.19 |
| Rate for Payer: Aetna of VT Commercial |
$183.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$163.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$161.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.26
|
| Rate for Payer: Cash Price |
$96.42
|
| Rate for Payer: Cigna Commercial |
$154.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.26
|
| Rate for Payer: Multiplan Commercial |
$179.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.91
|
| Rate for Payer: United Healthcare Commercial |
$183.19
|
|
|
CRYPTOSPORIDIUM AG IA
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
3008732801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$188.94 |
| Rate for Payer: Aetna of VT Commercial |
$188.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.62
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.63
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$21.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.82
|
| Rate for Payer: United Healthcare VA CCN |
$13.82
|
|
|
CRYPTOSPORIDIUM AG IA
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
3008732801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.80
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
|
|
CRYPTOSPORIDIUM AG IA
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
3008732801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna of VT Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.79
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.45
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.45
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.82
|
| Rate for Payer: United Healthcare VA CCN |
$90.45
|
|
|
CT ABDMN & PELVIS W/O CONTRAST
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 74176 26
|
| Hospital Charge Code |
9727417601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$185.77 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna of VT Commercial |
$238.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$213.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.80
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$200.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$233.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.35
|
| Rate for Payer: United Healthcare Commercial |
$238.45
|
|
|
CT ABDMN & PELVIS W/O CONTRAST
|
Facility
|
IP
|
$3,156.80
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
3527417601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,336.35 |
| Max. Negotiated Rate |
$2,998.96 |
| Rate for Payer: Aetna of VT Commercial |
$2,998.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,336.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,683.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,525.44
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cigna Commercial |
$2,525.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,525.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,525.44
|
| Rate for Payer: Multiplan Commercial |
$2,935.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,683.28
|
| Rate for Payer: United Healthcare Commercial |
$2,998.96
|
|
|
CT ABDMN & PELVIS W/O CONTRAST
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 74176 26
|
| Hospital Charge Code |
9727417601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.86 |
| Max. Negotiated Rate |
$460.55 |
| Rate for Payer: Aetna of VT Commercial |
$235.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.28
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$122.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.86
|
| Rate for Payer: Multiplan Commercial |
$233.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.86
|
| Rate for Payer: United Healthcare Commercial |
$119.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.86
|
| Rate for Payer: United Healthcare VA CCN |
$77.86
|
|
|
CT ABDMN & PELVIS W/O CONTRAST
|
Facility
|
OP
|
$3,156.80
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
3527417601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$460.55 |
| Max. Negotiated Rate |
$2,998.96 |
| Rate for Payer: Aetna of VT Commercial |
$2,998.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,398.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$460.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,900.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,683.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,557.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,420.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,509.66
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cigna Commercial |
$2,525.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,525.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,525.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,420.56
|
| Rate for Payer: Multiplan Commercial |
$2,935.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,683.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,420.56
|
| Rate for Payer: United Healthcare Commercial |
$2,998.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,420.56
|
| Rate for Payer: United Healthcare VA CCN |
$1,420.56
|
|
|
CT ABDMN & PELVIS W/O CONTRAST
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 74176 26
|
| Hospital Charge Code |
9727417601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$111.17 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna of VT Commercial |
$238.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$151.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$213.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.54
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$200.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.95
|
| Rate for Payer: Multiplan Commercial |
$233.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$213.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.95
|
| Rate for Payer: United Healthcare Commercial |
$238.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.95
|
| Rate for Payer: United Healthcare VA CCN |
$112.95
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 74177 26
|
| Hospital Charge Code |
9727417701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$210.40
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 74177 26
|
| Hospital Charge Code |
9727417701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.74 |
| Max. Negotiated Rate |
$980.67 |
| Rate for Payer: Aetna of VT Commercial |
$247.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$980.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.66
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$127.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.74
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$125.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.75
|
| Rate for Payer: United Healthcare VA CCN |
$81.75
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 74177 26
|
| Hospital Charge Code |
9727417701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna of VT Commercial |
$249.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$158.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$223.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.09
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$118.35
|
| Rate for Payer: Multiplan Commercial |
$244.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.35
|
| Rate for Payer: United Healthcare VA CCN |
$118.35
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
IP
|
$3,896.11
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
3527417701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,883.51 |
| Max. Negotiated Rate |
$3,701.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,701.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,883.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,883.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,311.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,272.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,116.89
|
| Rate for Payer: Cash Price |
$1,948.06
|
| Rate for Payer: Cigna Commercial |
$3,116.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,116.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,116.89
|
| Rate for Payer: Multiplan Commercial |
$3,623.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,311.69
|
| Rate for Payer: United Healthcare Commercial |
$3,701.30
|
|
|
CT ABDOMEN & PELVIS W/CONTRAST
|
Facility
|
OP
|
$3,896.11
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
3527417701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$980.67 |
| Max. Negotiated Rate |
$3,701.30 |
| Rate for Payer: Aetna of VT Commercial |
$3,701.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$980.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,725.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,345.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,311.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,155.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,753.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,097.41
|
| Rate for Payer: Cash Price |
$1,948.06
|
| Rate for Payer: Cash Price |
$1,948.06
|
| Rate for Payer: Cigna Commercial |
$3,116.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,116.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,116.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,753.25
|
| Rate for Payer: Multiplan Commercial |
$3,623.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,311.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,753.25
|
| Rate for Payer: United Healthcare Commercial |
$3,701.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,753.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,753.25
|
|
|
CT ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$2,537.31
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$2,410.44 |
| Rate for Payer: Aetna of VT Commercial |
$2,410.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,123.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,527.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,156.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,141.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,017.16
|
| Rate for Payer: Cash Price |
$1,268.65
|
| Rate for Payer: Cash Price |
$1,268.65
|
| Rate for Payer: Cigna Commercial |
$2,029.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,029.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,029.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,141.79
|
| Rate for Payer: Multiplan Commercial |
$2,359.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,156.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,141.79
|
| Rate for Payer: United Healthcare Commercial |
$2,410.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,141.79
|
| Rate for Payer: United Healthcare VA CCN |
$1,141.79
|
|
|
CT ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 74160 26
|
| Hospital Charge Code |
9727416001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.49 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.28
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare VA CCN |
$82.80
|
|
|
CT ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 74160 26
|
| Hospital Charge Code |
9727416001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.20
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
|
|
CT ABDOMEN W/CONTRAST
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 74160 26
|
| Hospital Charge Code |
9727416001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$772.63 |
| Rate for Payer: Aetna of VT Commercial |
$172.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.22
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$89.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.86
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.86
|
| Rate for Payer: United Healthcare Commercial |
$87.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.86
|
| Rate for Payer: United Healthcare VA CCN |
$56.86
|
|
|
CT ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$2,537.31
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,877.86 |
| Max. Negotiated Rate |
$2,410.44 |
| Rate for Payer: Aetna of VT Commercial |
$2,410.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,877.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,877.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,156.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,131.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,029.85
|
| Rate for Payer: Cash Price |
$1,268.65
|
| Rate for Payer: Cigna Commercial |
$2,029.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,029.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,029.85
|
| Rate for Payer: Multiplan Commercial |
$2,359.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,156.71
|
| Rate for Payer: United Healthcare Commercial |
$2,410.44
|
|
|
CT ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$2,097.99
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$365.34 |
| Max. Negotiated Rate |
$1,993.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$929.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,262.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,783.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,699.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$944.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,667.90
|
| Rate for Payer: Cash Price |
$1,048.99
|
| Rate for Payer: Cash Price |
$1,048.99
|
| Rate for Payer: Cigna Commercial |
$1,678.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,678.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,678.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$944.10
|
| Rate for Payer: Multiplan Commercial |
$1,951.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,783.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare Commercial |
$1,993.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$944.10
|
| Rate for Payer: United Healthcare VA CCN |
$944.10
|
|
|
CT ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 74150 26
|
| Hospital Charge Code |
9727415001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.18 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna of VT Commercial |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.74
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.40
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.40
|
| Rate for Payer: United Healthcare Commercial |
$163.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.40
|
| Rate for Payer: United Healthcare VA CCN |
$77.40
|
|
|
CT ABDOMEN W/O CONTRAST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 74150 26
|
| Hospital Charge Code |
9727415001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$365.34 |
| Rate for Payer: Aetna of VT Commercial |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.40
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$83.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.14
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.14
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.14
|
| Rate for Payer: United Healthcare VA CCN |
$53.14
|
|
|
CT ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 74150 26
|
| Hospital Charge Code |
9727415001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna of VT Commercial |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.60
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.60
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.20
|
| Rate for Payer: United Healthcare Commercial |
$163.40
|
|
|
CT ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$2,097.99
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,552.72 |
| Max. Negotiated Rate |
$1,993.09 |
| Rate for Payer: Aetna of VT Commercial |
$1,993.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,552.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,552.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,783.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,762.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,678.39
|
| Rate for Payer: Cash Price |
$1,048.99
|
| Rate for Payer: Cigna Commercial |
$1,678.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,678.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,678.39
|
| Rate for Payer: Multiplan Commercial |
$1,951.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,783.29
|
| Rate for Payer: United Healthcare Commercial |
$1,993.09
|
|
