|
CT ANGIOGRAPH PELVIS W/O&W/DYE
|
Facility
|
OP
|
$2,587.07
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
3527219101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$771.18 |
| Max. Negotiated Rate |
$2,457.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,457.72
|
| 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 |
$1,145.81
|
| 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 |
$1,557.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,095.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,164.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,056.72
|
| Rate for Payer: Cash Price |
$1,293.54
|
| Rate for Payer: Cash Price |
$1,293.54
|
| Rate for Payer: Cigna Commercial |
$2,069.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,069.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,069.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,164.18
|
| Rate for Payer: Multiplan Commercial |
$2,405.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,199.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,164.18
|
| Rate for Payer: United Healthcare Commercial |
$2,457.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,164.18
|
| Rate for Payer: United Healthcare VA CCN |
$1,164.18
|
|
|
CT ANGIOGRAPH PELVIS W/O&W/DYE
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 72191 26
|
| Hospital Charge Code |
9727219101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna of VT Commercial |
$242.52
|
| 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 |
$82.54
|
| 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 |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$134.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.27
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.14
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.14
|
| Rate for Payer: United Healthcare Commercial |
$123.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.14
|
| Rate for Payer: United Healthcare VA CCN |
$80.14
|
|
|
CT ANGIOGRAPH PELVIS W/O&W/DYE
|
Facility
|
IP
|
$2,587.07
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
3527219101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,914.69 |
| Max. Negotiated Rate |
$2,457.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,457.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,914.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,914.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,199.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,173.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,069.66
|
| Rate for Payer: Cash Price |
$1,293.54
|
| Rate for Payer: Cigna Commercial |
$2,069.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,069.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,069.66
|
| Rate for Payer: Multiplan Commercial |
$2,405.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,199.01
|
| Rate for Payer: United Healthcare Commercial |
$2,457.72
|
|
|
CT ANGIOGRAPH PELVIS W/O&W/DYE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 72191 26
|
| Hospital Charge Code |
9727219101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$190.95 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.40
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
|
|
CT ANGIOGRAPH PELVIS W/O&W/DYE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 72191 26
|
| Hospital Charge Code |
9727219101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare VA CCN |
$116.10
|
|
|
CT ANGIOGRAPHY CHEST W/O&W/DYE
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 71275 26
|
| Hospital Charge Code |
9727127501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$262.74 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$262.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.00
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
|
|
CT ANGIOGRAPHY CHEST W/O&W/DYE
|
Facility
|
OP
|
$2,556.05
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
3527127501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$2,428.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,428.25
|
| 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 |
$1,132.07
|
| 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 |
$1,538.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,172.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,070.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,150.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,032.06
|
| Rate for Payer: Cash Price |
$1,278.03
|
| Rate for Payer: Cash Price |
$1,278.03
|
| Rate for Payer: Cigna Commercial |
$2,044.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,044.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,044.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,150.22
|
| Rate for Payer: Multiplan Commercial |
$2,377.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,172.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,150.22
|
| Rate for Payer: United Healthcare Commercial |
$2,428.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,150.22
|
| Rate for Payer: United Healthcare VA CCN |
$1,150.22
|
|
|
CT ANGIOGRAPHY CHEST W/O&W/DYE
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 71275 26
|
| Hospital Charge Code |
9727127501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna of VT Commercial |
$337.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$157.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$213.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$301.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$287.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.23
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$301.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$337.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.75
|
| Rate for Payer: United Healthcare VA CCN |
$159.75
|
|
|
CT ANGIOGRAPHY CHEST W/O&W/DYE
|
Facility
|
IP
|
$2,556.05
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
3527127501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,891.73 |
| Max. Negotiated Rate |
$2,428.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,428.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,891.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,891.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,172.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,147.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,044.84
|
| Rate for Payer: Cash Price |
$1,278.03
|
| Rate for Payer: Cigna Commercial |
$2,044.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,044.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,044.84
|
| Rate for Payer: Multiplan Commercial |
$2,377.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,172.64
|
| Rate for Payer: United Healthcare Commercial |
$2,428.25
|
|
|
CT ANGIOGRAPHY CHEST W/O&W/DYE
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 71275 26
|
| Hospital Charge Code |
9727127501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Aetna of VT Commercial |
$333.70
|
| 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 |
$83.86
|
| 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 |
$113.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.22
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$127.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.42
|
| Rate for Payer: Multiplan Commercial |
$330.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.42
|
| Rate for Payer: United Healthcare Commercial |
$125.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.42
|
| Rate for Payer: United Healthcare VA CCN |
$81.42
|
|
|
CT ANGIOGRAPHY HEAD W/ W/O DYE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 70496 26
|
| Hospital Charge Code |
9727049601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
|
|
CT ANGIOGRAPHY HEAD W/ W/O DYE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 70496 26
|
| Hospital Charge Code |
9727049601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$78.18 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Aetna of VT Commercial |
$305.50
|
| 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 |
$80.53
|
| 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 |
$109.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.35
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$122.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.18
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.18
|
| Rate for Payer: United Healthcare Commercial |
$120.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.18
|
| Rate for Payer: United Healthcare VA CCN |
$78.18
|
|
|
CT ANGIOGRAPHY HEAD W/ W/O DYE
|
Facility
|
IP
|
$3,137.41
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
3517049601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,322.00 |
| Max. Negotiated Rate |
$2,980.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,322.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,322.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,635.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,509.93
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cigna Commercial |
$2,509.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.93
|
| Rate for Payer: Multiplan Commercial |
$2,917.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.80
|
| Rate for Payer: United Healthcare Commercial |
$2,980.54
|
|
|
CT ANGIOGRAPHY HEAD W/ W/O DYE
|
Facility
|
OP
|
$3,137.41
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
3517049601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$2,980.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.54
|
| 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 |
$1,389.56
|
| 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 |
$1,888.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,541.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,411.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,494.24
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cigna Commercial |
$2,509.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,411.83
|
| Rate for Payer: Multiplan Commercial |
$2,917.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,411.83
|
| Rate for Payer: United Healthcare Commercial |
$2,980.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,411.83
|
| Rate for Payer: United Healthcare VA CCN |
$1,411.83
|
|
|
CT ANGIOGRAPHY HEAD W/ W/O DYE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 70496 26
|
| Hospital Charge Code |
9727049601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.38
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare VA CCN |
$146.25
|
|
|
CT ANGIOGRAPHY NECK W/ W/O DYE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 70498 26
|
| Hospital Charge Code |
9727049801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
|
|
CT ANGIOGRAPHY NECK W/ W/O DYE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 70498 26
|
| Hospital Charge Code |
9727049801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.38
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare VA CCN |
$146.25
|
|
|
CT ANGIOGRAPHY NECK W/ W/O DYE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 70498 26
|
| Hospital Charge Code |
9727049801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$78.18 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Aetna of VT Commercial |
$305.50
|
| 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 |
$80.53
|
| 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 |
$109.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.35
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$122.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.18
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.18
|
| Rate for Payer: United Healthcare Commercial |
$120.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.18
|
| Rate for Payer: United Healthcare VA CCN |
$78.18
|
|
|
CT ANGIOGRAPHY NECK W/ W/O DYE
|
Facility
|
OP
|
$2,939.66
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
3527049801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$2,792.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,792.68
|
| 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 |
$1,301.98
|
| 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 |
$1,769.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,498.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,381.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,322.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,337.03
|
| Rate for Payer: Cash Price |
$1,469.83
|
| Rate for Payer: Cash Price |
$1,469.83
|
| Rate for Payer: Cigna Commercial |
$2,351.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,351.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,351.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,322.85
|
| Rate for Payer: Multiplan Commercial |
$2,733.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,498.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,322.85
|
| Rate for Payer: United Healthcare Commercial |
$2,792.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,322.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,322.85
|
|
|
CT ANGIOGRAPHY NECK W/ W/O DYE
|
Facility
|
IP
|
$2,939.66
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
3527049801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,175.64 |
| Max. Negotiated Rate |
$2,792.68 |
| Rate for Payer: Aetna of VT Commercial |
$2,792.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,175.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,175.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,498.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,469.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,351.73
|
| Rate for Payer: Cash Price |
$1,469.83
|
| Rate for Payer: Cigna Commercial |
$2,351.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,351.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,351.73
|
| Rate for Payer: Multiplan Commercial |
$2,733.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,498.71
|
| Rate for Payer: United Healthcare Commercial |
$2,792.68
|
|
|
CT ANGIOGRAPHY UPPER EXTREMITY
|
Facility
|
OP
|
$2,738.03
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
35273206RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$771.18 |
| Max. Negotiated Rate |
$2,601.13 |
| Rate for Payer: Aetna of VT Commercial |
$2,601.13
|
| 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 |
$1,212.67
|
| 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 |
$1,648.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,327.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,217.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,232.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,176.73
|
| Rate for Payer: Cash Price |
$1,369.02
|
| Rate for Payer: Cash Price |
$1,369.02
|
| Rate for Payer: Cigna Commercial |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,190.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,232.11
|
| Rate for Payer: Multiplan Commercial |
$2,546.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,327.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,232.11
|
| Rate for Payer: United Healthcare Commercial |
$2,601.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,232.11
|
| Rate for Payer: United Healthcare VA CCN |
$1,232.11
|
|
|
CT ANGIOGRAPHY UPPER EXTREMITY
|
Facility
|
IP
|
$2,738.03
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
35273206LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,026.42 |
| Max. Negotiated Rate |
$2,601.13 |
| Rate for Payer: Aetna of VT Commercial |
$2,601.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,026.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,026.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,327.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,299.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,190.42
|
| Rate for Payer: Cash Price |
$1,369.02
|
| Rate for Payer: Cigna Commercial |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,190.42
|
| Rate for Payer: Multiplan Commercial |
$2,546.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,327.33
|
| Rate for Payer: United Healthcare Commercial |
$2,601.13
|
|
|
CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 73206 26
|
| Hospital Charge Code |
9727320601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna of VT Commercial |
$242.52
|
| 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 |
$82.54
|
| 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 |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.73
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$125.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.14
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.14
|
| Rate for Payer: United Healthcare Commercial |
$123.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.14
|
| Rate for Payer: United Healthcare VA CCN |
$80.14
|
|
|
CT ANGIOGRAPHY UPPER EXTREMITY
|
Facility
|
IP
|
$2,738.03
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
35273206RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,026.42 |
| Max. Negotiated Rate |
$2,601.13 |
| Rate for Payer: Aetna of VT Commercial |
$2,601.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,026.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,026.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,327.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,299.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,190.42
|
| Rate for Payer: Cash Price |
$1,369.02
|
| Rate for Payer: Cigna Commercial |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,190.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,190.42
|
| Rate for Payer: Multiplan Commercial |
$2,546.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,327.33
|
| Rate for Payer: United Healthcare Commercial |
$2,601.13
|
|
|
CT ANGIOGRAPHY UPPER EXTREMITY
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 73206 26
|
| Hospital Charge Code |
9727320601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$190.95 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.40
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
|
