|
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
|
$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
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
IP
|
$2,605.68
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
3507557401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,928.46 |
| Max. Negotiated Rate |
$2,475.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,475.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,928.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,928.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,214.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,188.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,084.54
|
| Rate for Payer: Cash Price |
$1,302.84
|
| Rate for Payer: Cigna Commercial |
$2,084.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,084.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,084.54
|
| Rate for Payer: Multiplan Commercial |
$2,423.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,214.83
|
| Rate for Payer: United Healthcare Commercial |
$2,475.40
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 75574 26
|
| Hospital Charge Code |
9727557401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.94 |
| Max. Negotiated Rate |
$771.01 |
| Rate for Payer: Aetna of VT Commercial |
$319.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.01
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$167.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.95
|
| Rate for Payer: Multiplan Commercial |
$316.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.94
|
| Rate for Payer: United Healthcare Commercial |
$164.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.94
|
| Rate for Payer: United Healthcare VA CCN |
$106.94
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
OP
|
$2,605.68
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
3507557401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$771.01 |
| Max. Negotiated Rate |
$2,475.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,475.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,154.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,568.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,214.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,110.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,172.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,071.52
|
| Rate for Payer: Cash Price |
$1,302.84
|
| Rate for Payer: Cash Price |
$1,302.84
|
| Rate for Payer: Cigna Commercial |
$2,084.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,084.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,084.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,172.56
|
| Rate for Payer: Multiplan Commercial |
$2,423.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,214.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,172.56
|
| Rate for Payer: United Healthcare Commercial |
$2,475.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,172.56
|
| Rate for Payer: United Healthcare VA CCN |
$1,172.56
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 75574 26
|
| Hospital Charge Code |
9727557401
|
|
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 HRT W/3D IMAGE
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 75574 26
|
| Hospital Charge Code |
9727557401
|
|
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 LOWER EXTRM W/O&W/DYE
|
Facility
|
OP
|
$1,974.94
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
3527370650
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna of VT Commercial |
$1,876.19
|
| 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 |
$874.70
|
| 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 |
$1,188.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,678.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,599.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$888.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,570.08
|
| Rate for Payer: Cash Price |
$987.47
|
| Rate for Payer: Cash Price |
$987.47
|
| Rate for Payer: Cigna Commercial |
$1,579.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,579.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,579.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$888.72
|
| Rate for Payer: Multiplan Commercial |
$1,836.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,678.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$888.72
|
| Rate for Payer: United Healthcare Commercial |
$1,876.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$888.72
|
| Rate for Payer: United Healthcare VA CCN |
$888.72
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
IP
|
$1,974.94
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
3527370650
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,461.65 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna of VT Commercial |
$1,876.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,461.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,461.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,678.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,658.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,579.95
|
| Rate for Payer: Cash Price |
$987.47
|
| Rate for Payer: Cigna Commercial |
$1,579.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,579.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,579.95
|
| Rate for Payer: Multiplan Commercial |
$1,836.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,678.70
|
| Rate for Payer: United Healthcare Commercial |
$1,876.19
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
IP
|
$2,761.61
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
35273706LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,043.87 |
| Max. Negotiated Rate |
$2,623.53 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,043.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,043.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,319.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,209.29
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cigna Commercial |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.29
|
| Rate for Payer: Multiplan Commercial |
$2,568.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.37
|
| Rate for Payer: United Healthcare Commercial |
$2,623.53
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
CPT 73706 26
|
| Hospital Charge Code |
9727370601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$84.33 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Aetna of VT Commercial |
$253.80
|
| 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 |
$86.86
|
| 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 |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.59
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$132.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.33
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.33
|
| Rate for Payer: United Healthcare Commercial |
$129.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.33
|
| Rate for Payer: United Healthcare VA CCN |
$84.33
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
OP
|
$2,761.61
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
35273706LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$2,623.53 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.53
|
| 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 |
$1,223.12
|
| 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 |
$1,662.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,236.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,242.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,195.48
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cigna Commercial |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,242.72
|
| Rate for Payer: Multiplan Commercial |
$2,568.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,242.72
|
| Rate for Payer: United Healthcare Commercial |
$2,623.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,242.72
|
| Rate for Payer: United Healthcare VA CCN |
$1,242.72
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 73706 26
|
| Hospital Charge Code |
9727370601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$199.83 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of VT Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
IP
|
$2,761.61
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
35273706RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,043.87 |
| Max. Negotiated Rate |
$2,623.53 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,043.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,043.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,319.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,209.29
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cigna Commercial |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.29
|
| Rate for Payer: Multiplan Commercial |
$2,568.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.37
|
| Rate for Payer: United Healthcare Commercial |
$2,623.53
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 73706 26
|
| Hospital Charge Code |
9727370601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$119.58 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of VT Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.65
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare VA CCN |
$121.50
|
|
|
CT ANGIO LOWER EXTRM W/O&W/DYE
|
Facility
|
OP
|
$2,761.61
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
35273706RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.42 |
| Max. Negotiated Rate |
$2,623.53 |
| Rate for Payer: Aetna of VT Commercial |
$2,623.53
|
| 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 |
$1,223.12
|
| 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 |
$1,662.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,347.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,236.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,242.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,195.48
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cash Price |
$1,380.81
|
| Rate for Payer: Cigna Commercial |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,209.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,209.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,242.72
|
| Rate for Payer: Multiplan Commercial |
$2,568.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,347.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,242.72
|
| Rate for Payer: United Healthcare Commercial |
$2,623.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,242.72
|
| Rate for Payer: United Healthcare VA CCN |
$1,242.72
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
CPT 72126 26
|
| Hospital Charge Code |
9727212601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Aetna of VT Commercial |
$205.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.53
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$85.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.43
|
| Rate for Payer: Multiplan Commercial |
$203.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.43
|
| Rate for Payer: United Healthcare Commercial |
$83.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.43
|
| Rate for Payer: United Healthcare VA CCN |
$54.43
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
OP
|
$2,736.58
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
3527212601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$502.46 |
| Max. Negotiated Rate |
$2,599.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,599.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$502.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,212.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$502.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,647.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,326.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,216.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,231.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,175.58
|
| Rate for Payer: Cash Price |
$1,368.29
|
| Rate for Payer: Cash Price |
$1,368.29
|
| Rate for Payer: Cigna Commercial |
$2,189.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,189.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,189.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,231.46
|
| Rate for Payer: Multiplan Commercial |
$2,545.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,326.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,231.46
|
| Rate for Payer: United Healthcare Commercial |
$2,599.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,231.46
|
| Rate for Payer: United Healthcare VA CCN |
$1,231.46
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT 72126 26
|
| Hospital Charge Code |
9727212601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna of VT Commercial |
$208.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.10
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$175.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$203.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$208.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.55
|
| Rate for Payer: United Healthcare VA CCN |
$98.55
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT 72126 26
|
| Hospital Charge Code |
9727212601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna of VT Commercial |
$208.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.20
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cigna Commercial |
$175.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$203.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.15
|
| Rate for Payer: United Healthcare Commercial |
$208.05
|
|
|
CT CERVICAL SPINE W/CONTRAST
|
Facility
|
IP
|
$2,736.58
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
3527212601
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,025.34 |
| Max. Negotiated Rate |
$2,599.75 |
| Rate for Payer: Aetna of VT Commercial |
$2,599.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,025.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,025.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,326.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,298.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,189.26
|
| Rate for Payer: Cash Price |
$1,368.29
|
| Rate for Payer: Cigna Commercial |
$2,189.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,189.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,189.26
|
| Rate for Payer: Multiplan Commercial |
$2,545.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,326.09
|
| Rate for Payer: United Healthcare Commercial |
$2,599.75
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 72125 26
|
| Hospital Charge Code |
9727212501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.20
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,156.92
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
3527212501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$375.45 |
| Max. Negotiated Rate |
$2,049.07 |
| Rate for Payer: Aetna of VT Commercial |
$2,049.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$955.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,298.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,833.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,747.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$970.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,078.46
|
| Rate for Payer: Cash Price |
$1,078.46
|
| Rate for Payer: Cigna Commercial |
$1,725.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,725.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,725.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$970.61
|
| Rate for Payer: Multiplan Commercial |
$2,005.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,833.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$970.61
|
| Rate for Payer: United Healthcare Commercial |
$2,049.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$970.61
|
| Rate for Payer: United Healthcare VA CCN |
$970.61
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,156.92
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
3527212501
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,596.34 |
| Max. Negotiated Rate |
$2,049.07 |
| Rate for Payer: Aetna of VT Commercial |
$2,049.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,596.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,596.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,833.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,811.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,725.54
|
| Rate for Payer: Cash Price |
$1,078.46
|
| Rate for Payer: Cigna Commercial |
$1,725.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,725.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,725.54
|
| Rate for Payer: Multiplan Commercial |
$2,005.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,833.38
|
| Rate for Payer: United Healthcare Commercial |
$2,049.07
|
|
|
CT CERVICAL SPINE W/O CONTRAST
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 72125 26
|
| Hospital Charge Code |
9727212501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$375.45 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.46
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$70.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
