|
CT ABDOMEN W/O & W/CONTRAST
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 74170 26
|
| Hospital Charge Code |
9727417001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna of VT Commercial |
$191.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.59
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.90
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.90
|
| Rate for Payer: United Healthcare Commercial |
$191.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.90
|
| Rate for Payer: United Healthcare VA CCN |
$90.90
|
|
|
CT ABDOMEN W/O & W/CONTRAST
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 74170 26
|
| Hospital Charge Code |
9727417001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna of VT Commercial |
$191.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.60
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$161.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$161.60
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$171.70
|
| Rate for Payer: United Healthcare Commercial |
$191.90
|
|
|
CT ABDOMEN W/O & W/CONTRAST
|
Facility
|
IP
|
$3,383.51
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,504.14 |
| Max. Negotiated Rate |
$3,214.33 |
| Rate for Payer: Aetna of VT Commercial |
$3,214.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,504.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,504.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,875.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,842.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,706.81
|
| Rate for Payer: Cash Price |
$1,691.76
|
| Rate for Payer: Cigna Commercial |
$2,706.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,706.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,706.81
|
| Rate for Payer: Multiplan Commercial |
$3,146.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,875.98
|
| Rate for Payer: United Healthcare Commercial |
$3,214.33
|
|
|
CT ABDOMEN W/O & W/CONTRAST
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 74170 26
|
| Hospital Charge Code |
9727417001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.35 |
| Max. Negotiated Rate |
$772.63 |
| Rate for Payer: Aetna of VT Commercial |
$189.88
|
| 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 |
$64.22
|
| 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 |
$87.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.59
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$98.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.35
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.35
|
| Rate for Payer: United Healthcare Commercial |
$95.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.35
|
| Rate for Payer: United Healthcare VA CCN |
$62.35
|
|
|
CT ABDOMEN W/O & W/CONTRAST
|
Facility
|
OP
|
$3,383.51
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$3,214.33 |
| Rate for Payer: Aetna of VT Commercial |
$3,214.33
|
| 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 |
$1,498.56
|
| 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 |
$2,036.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,875.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,740.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,522.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,689.89
|
| Rate for Payer: Cash Price |
$1,691.76
|
| Rate for Payer: Cash Price |
$1,691.76
|
| Rate for Payer: Cigna Commercial |
$2,706.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,706.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,706.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,522.58
|
| Rate for Payer: Multiplan Commercial |
$3,146.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,875.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,522.58
|
| Rate for Payer: United Healthcare Commercial |
$3,214.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,522.58
|
| Rate for Payer: United Healthcare VA CCN |
$1,522.58
|
|
|
CT ADB & PLEV W/O DYE 1/> REGN
|
Facility
|
OP
|
$4,927.01
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,107.63 |
| Max. Negotiated Rate |
$4,680.66 |
| Rate for Payer: Aetna of VT Commercial |
$4,680.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,107.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,182.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,107.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,966.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,187.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,990.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,217.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,916.97
|
| Rate for Payer: Cash Price |
$2,463.50
|
| Rate for Payer: Cash Price |
$2,463.50
|
| Rate for Payer: Cigna Commercial |
$3,941.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,941.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,941.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,217.15
|
| Rate for Payer: Multiplan Commercial |
$4,582.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,187.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,217.15
|
| Rate for Payer: United Healthcare Commercial |
$4,680.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,217.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,217.15
|
|
|
CT ADB & PLEV W/O DYE 1/> REGN
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 74178 26
|
| Hospital Charge Code |
9727417801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,107.63 |
| Rate for Payer: Aetna of VT Commercial |
$270.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,107.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,107.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.35
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$140.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare Commercial |
$138.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare VA CCN |
$89.82
|
|
|
CT ADB & PLEV W/O DYE 1/> REGN
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 74178 26
|
| Hospital Charge Code |
9727417801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of VT Commercial |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.96
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.60
|
| Rate for Payer: United Healthcare VA CCN |
$129.60
|
|
|
CT ADB & PLEV W/O DYE 1/> REGN
|
Facility
|
IP
|
$4,927.01
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,646.48 |
| Max. Negotiated Rate |
$4,680.66 |
| Rate for Payer: Aetna of VT Commercial |
$4,680.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,646.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,646.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,187.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,138.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,941.61
|
| Rate for Payer: Cash Price |
$2,463.50
|
| Rate for Payer: Cigna Commercial |
$3,941.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,941.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,941.61
|
| Rate for Payer: Multiplan Commercial |
$4,582.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,187.96
|
| Rate for Payer: United Healthcare Commercial |
$4,680.66
|
|
|
CT ADB & PLEV W/O DYE 1/> REGN
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 74178 26
|
| Hospital Charge Code |
9727417801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of VT Commercial |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$230.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$267.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
CT ANGIO ABDOMEN W/O & W/DYE
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3527417501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,183.30 |
| Max. Negotiated Rate |
$2,802.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,802.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,183.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,183.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,507.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,478.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,360.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,360.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,360.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,360.00
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,507.50
|
| Rate for Payer: United Healthcare Commercial |
$2,802.50
|
|
|
CT ANGIO ABDOMEN W/O & W/DYE
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3527417501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$771.18 |
| Max. Negotiated Rate |
$2,802.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,802.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,306.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,775.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,507.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,389.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,327.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,345.25
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,360.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,360.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,360.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,327.50
|
| Rate for Payer: Multiplan Commercial |
$2,743.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,507.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,327.50
|
| Rate for Payer: United Healthcare Commercial |
$2,802.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,327.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,327.50
|
|
|
CT ANGIO ABDOMEN W/O & W/DYE
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 74175 26
|
| Hospital Charge Code |
9727417501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.10 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna of VT Commercial |
$245.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.31
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$127.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.11
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.10
|
| Rate for Payer: United Healthcare Commercial |
$124.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.10
|
| Rate for Payer: United Healthcare VA CCN |
$81.10
|
|
|
CT ANGIO ABDOMEN W/O & W/DYE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 74175 26
|
| Hospital Charge Code |
9727417501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
CT ANGIO ABDOMEN W/O & W/DYE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 74175 26
|
| Hospital Charge Code |
9727417501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
IP
|
$3,204.37
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
3527563501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,371.55 |
| Max. Negotiated Rate |
$3,044.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,044.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,371.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,371.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,723.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,691.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,563.50
|
| Rate for Payer: Cash Price |
$1,602.18
|
| Rate for Payer: Cigna Commercial |
$2,563.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,563.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,563.50
|
| Rate for Payer: Multiplan Commercial |
$2,980.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,723.71
|
| Rate for Payer: United Healthcare Commercial |
$3,044.15
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 75635 26
|
| Hospital Charge Code |
9727563501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$150.59 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of VT Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$150.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$204.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.30
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$316.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$323.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.00
|
| Rate for Payer: United Healthcare VA CCN |
$153.00
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 75635 26
|
| Hospital Charge Code |
9727563501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$251.63 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of VT Commercial |
$323.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$251.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$251.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.00
|
| Rate for Payer: Multiplan Commercial |
$316.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.00
|
| Rate for Payer: United Healthcare Commercial |
$323.00
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
OP
|
$3,204.37
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
3527563501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$3,044.15 |
| Rate for Payer: Aetna of VT Commercial |
$3,044.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,419.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,929.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,723.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,595.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,441.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,547.47
|
| Rate for Payer: Cash Price |
$1,602.18
|
| Rate for Payer: Cash Price |
$1,602.18
|
| Rate for Payer: Cigna Commercial |
$2,563.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,563.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,563.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,441.97
|
| Rate for Payer: Multiplan Commercial |
$2,980.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,723.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,441.97
|
| Rate for Payer: United Healthcare Commercial |
$3,044.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,441.97
|
| Rate for Payer: United Healthcare VA CCN |
$1,441.97
|
|
|
CT ANGIO ABDOMINAL ARTERIES
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 75635 26
|
| Hospital Charge Code |
9727563501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$105.83 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Aetna of VT Commercial |
$319.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.86
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$166.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.83
|
| Rate for Payer: Multiplan Commercial |
$316.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.83
|
| Rate for Payer: United Healthcare Commercial |
$162.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.83
|
| Rate for Payer: United Healthcare VA CCN |
$105.83
|
|
|
CT ANGIO ABDOMN&PELV W/O&W/DYE
|
Facility
|
IP
|
$3,273.64
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
3527417401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,422.82 |
| Max. Negotiated Rate |
$3,109.96 |
| Rate for Payer: Aetna of VT Commercial |
$3,109.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,422.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,422.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,782.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,749.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,618.91
|
| Rate for Payer: Cash Price |
$1,636.82
|
| Rate for Payer: Cigna Commercial |
$2,618.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,618.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,618.91
|
| Rate for Payer: Multiplan Commercial |
$3,044.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,782.59
|
| Rate for Payer: United Healthcare Commercial |
$3,109.96
|
|
|
CT ANGIO ABDOMN&PELV W/O&W/DYE
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 74174 26
|
| Hospital Charge Code |
9727417401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$1,247.60 |
| Rate for Payer: Aetna of VT Commercial |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,247.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,247.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.66
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$153.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.07
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.07
|
| Rate for Payer: United Healthcare Commercial |
$150.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.07
|
| Rate for Payer: United Healthcare VA CCN |
$98.07
|
|
|
CT ANGIO ABDOMN&PELV W/O&W/DYE
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 74174 26
|
| Hospital Charge Code |
9727417401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$139.51 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna of VT Commercial |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$282.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$282.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$250.43
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.75
|
| Rate for Payer: United Healthcare Commercial |
$299.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.75
|
| Rate for Payer: United Healthcare VA CCN |
$141.75
|
|
|
CT ANGIO ABDOMN&PELV W/O&W/DYE
|
Facility
|
OP
|
$3,273.64
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
3527417401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,247.60 |
| Max. Negotiated Rate |
$3,109.96 |
| Rate for Payer: Aetna of VT Commercial |
$3,109.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,247.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,449.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,247.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,970.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,782.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,651.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,473.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,602.54
|
| Rate for Payer: Cash Price |
$1,636.82
|
| Rate for Payer: Cash Price |
$1,636.82
|
| Rate for Payer: Cigna Commercial |
$2,618.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,618.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,618.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,473.14
|
| Rate for Payer: Multiplan Commercial |
$3,044.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,782.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,473.14
|
| Rate for Payer: United Healthcare Commercial |
$3,109.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,473.14
|
| Rate for Payer: United Healthcare VA CCN |
$1,473.14
|
|
|
CT ANGIO ABDOMN&PELV W/O&W/DYE
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 74174 26
|
| Hospital Charge Code |
9727417401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$233.13 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna of VT Commercial |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$299.25
|
|
