|
CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 72125 26
|
| Hospital Charge Code |
9727212501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$92.57 |
| 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 |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.16
|
| 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: Martins Point Health Care Commercial |
$94.05
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare VA CCN |
$94.05
|
|
|
CT CERVICAL SPINE W/O &W/CONTR
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 72127 26
|
| Hospital Charge Code |
9727212701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.20
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
|
|
CT CERVICAL SPINE W/O &W/CONTR
|
Facility
|
IP
|
$3,488.41
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
3527212701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,581.77 |
| Max. Negotiated Rate |
$3,313.99 |
| Rate for Payer: Aetna of VT Commercial |
$3,313.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,581.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,581.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,965.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,930.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,744.20
|
| Rate for Payer: Cigna Commercial |
$2,790.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,790.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,790.73
|
| Rate for Payer: Multiplan Commercial |
$3,244.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,965.15
|
| Rate for Payer: United Healthcare Commercial |
$3,313.99
|
|
|
CT CERVICAL SPINE W/O &W/CONTR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 72127 26
|
| Hospital Charge Code |
9727212701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.49 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.28
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare VA CCN |
$82.80
|
|
|
CT CERVICAL SPINE W/O &W/CONTR
|
Facility
|
OP
|
$3,488.41
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
3527212701
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$620.92 |
| Max. Negotiated Rate |
$3,313.99 |
| Rate for Payer: Aetna of VT Commercial |
$3,313.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,545.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,100.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,965.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,825.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,569.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,773.29
|
| Rate for Payer: Cash Price |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,744.20
|
| Rate for Payer: Cigna Commercial |
$2,790.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,790.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,790.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,569.78
|
| Rate for Payer: Multiplan Commercial |
$3,244.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,965.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,569.78
|
| Rate for Payer: United Healthcare Commercial |
$3,313.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,569.78
|
| Rate for Payer: United Healthcare VA CCN |
$1,569.78
|
|
|
CT CERVICAL SPINE W/O &W/CONTR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 72127 26
|
| Hospital Charge Code |
9727212701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.54 |
| Max. Negotiated Rate |
$620.92 |
| Rate for Payer: Aetna of VT Commercial |
$172.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$89.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.54
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.54
|
| Rate for Payer: United Healthcare Commercial |
$86.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.54
|
| Rate for Payer: United Healthcare VA CCN |
$56.54
|
|
|
CT DX THORAX W/CONTRAST
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 71260 26
|
| Hospital Charge Code |
9727126001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$505.31 |
| Rate for Payer: Aetna of VT Commercial |
$208.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.05
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$82.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.17
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.17
|
| Rate for Payer: United Healthcare Commercial |
$80.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.17
|
| Rate for Payer: United Healthcare VA CCN |
$52.17
|
|
|
CT DX THORAX W/CONTRAST
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 71260 26
|
| Hospital Charge Code |
9727126001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.60
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
|
|
CT DX THORAX W/CONTRAST
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 71260 26
|
| Hospital Charge Code |
9727126001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna of VT Commercial |
$210.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$179.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.49
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.90
|
| Rate for Payer: Multiplan Commercial |
$206.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare Commercial |
$210.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.90
|
| Rate for Payer: United Healthcare VA CCN |
$99.90
|
|
|
CT DX THORAX W/CONTRAST
|
Facility
|
IP
|
$2,461.81
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
3527126001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,821.99 |
| Max. Negotiated Rate |
$2,338.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,338.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,821.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,821.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,092.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,067.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,969.45
|
| Rate for Payer: Cash Price |
$1,230.90
|
| Rate for Payer: Cigna Commercial |
$1,969.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,969.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,969.45
|
| Rate for Payer: Multiplan Commercial |
$2,289.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,092.54
|
| Rate for Payer: United Healthcare Commercial |
$2,338.72
|
|
|
CT DX THORAX W/CONTRAST
|
Facility
|
OP
|
$2,461.81
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
3527126001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$505.31 |
| Max. Negotiated Rate |
$2,338.72 |
| Rate for Payer: Aetna of VT Commercial |
$2,338.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$505.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,090.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$505.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,482.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,092.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,994.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,107.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,957.14
|
| Rate for Payer: Cash Price |
$1,230.90
|
| Rate for Payer: Cash Price |
$1,230.90
|
| Rate for Payer: Cigna Commercial |
$1,969.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,969.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,969.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,107.81
|
| Rate for Payer: Multiplan Commercial |
$2,289.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,092.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,107.81
|
| Rate for Payer: United Healthcare Commercial |
$2,338.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,107.81
|
| Rate for Payer: United Healthcare VA CCN |
$1,107.81
|
|
|
CT DX THORAX W/O CONTRAST
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 71250 26
|
| Hospital Charge Code |
9727125001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$371.14 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.60
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.30
|
| Rate for Payer: United Healthcare Commercial |
$74.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.30
|
| Rate for Payer: United Healthcare VA CCN |
$48.30
|
|
|
CT DX THORAX W/O CONTRAST
|
Facility
|
IP
|
$1,985.28
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
3527125001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,469.31 |
| Max. Negotiated Rate |
$1,886.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,886.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,469.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,469.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,687.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,667.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,588.22
|
| Rate for Payer: Cash Price |
$992.64
|
| Rate for Payer: Cigna Commercial |
$1,588.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,588.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,588.22
|
| Rate for Payer: Multiplan Commercial |
$1,846.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,687.49
|
| Rate for Payer: United Healthcare Commercial |
$1,886.02
|
|
|
CT DX THORAX W/O CONTRAST
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 71250 26
|
| Hospital Charge Code |
9727125001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$92.57 |
| 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 |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$169.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.16
|
| 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: Martins Point Health Care Commercial |
$94.05
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.05
|
| Rate for Payer: United Healthcare VA CCN |
$94.05
|
|
|
CT DX THORAX W/O CONTRAST
|
Facility
|
OP
|
$1,985.28
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
3527125001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$371.14 |
| Max. Negotiated Rate |
$1,886.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,886.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$879.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,195.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,687.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,608.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$893.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,578.30
|
| Rate for Payer: Cash Price |
$992.64
|
| Rate for Payer: Cash Price |
$992.64
|
| Rate for Payer: Cigna Commercial |
$1,588.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,588.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,588.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$893.38
|
| Rate for Payer: Multiplan Commercial |
$1,846.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,687.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$893.38
|
| Rate for Payer: United Healthcare Commercial |
$1,886.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$893.38
|
| Rate for Payer: United Healthcare VA CCN |
$893.38
|
|
|
CT DX THORAX W/O CONTRAST
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 71250 26
|
| Hospital Charge Code |
9727125001
|
|
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 DX THORAX W/O & W/CONTRAST
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 71270 26
|
| Hospital Charge Code |
9727127001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.40
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
|
|
CT DX THORAX W/O & W/CONTRAST
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 71270 26
|
| Hospital Charge Code |
9727127001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.16
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare VA CCN |
$111.60
|
|
|
CT DX THORAX W/O & W/CONTRAST
|
Facility
|
IP
|
$3,073.05
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,274.36 |
| Max. Negotiated Rate |
$2,919.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,919.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,274.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,274.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,612.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,581.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,458.44
|
| Rate for Payer: Cash Price |
$1,536.53
|
| Rate for Payer: Cigna Commercial |
$2,458.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,458.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,458.44
|
| Rate for Payer: Multiplan Commercial |
$2,857.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,612.09
|
| Rate for Payer: United Healthcare Commercial |
$2,919.40
|
|
|
CT DX THORAX W/O & W/CONTRAST
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 71270 26
|
| Hospital Charge Code |
9727127001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.89 |
| Max. Negotiated Rate |
$619.47 |
| Rate for Payer: Aetna of VT Commercial |
$233.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$619.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$619.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.96
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$87.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.89
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$85.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.89
|
| Rate for Payer: United Healthcare VA CCN |
$55.89
|
|
|
CT DX THORAX W/O & W/CONTRAST
|
Facility
|
OP
|
$3,073.05
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
3527127001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$619.47 |
| Max. Negotiated Rate |
$2,919.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,919.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$619.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,361.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$619.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,849.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,612.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,489.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,382.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,443.07
|
| Rate for Payer: Cash Price |
$1,536.53
|
| Rate for Payer: Cash Price |
$1,536.53
|
| Rate for Payer: Cigna Commercial |
$2,458.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,458.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,458.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,382.87
|
| Rate for Payer: Multiplan Commercial |
$2,857.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,612.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,382.87
|
| Rate for Payer: United Healthcare Commercial |
$2,919.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,382.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,382.87
|
|
|
CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 77012 26
|
| Hospital Charge Code |
9727701201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$65.27 |
| Max. Negotiated Rate |
$306.11 |
| Rate for Payer: Aetna of VT Commercial |
$200.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.11
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$98.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.27
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.28
|
| Rate for Payer: United Healthcare Commercial |
$100.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.28
|
| Rate for Payer: United Healthcare VA CCN |
$65.28
|
|
|
CT GUIDANCE NEEDLE PLACEMENT
|
Facility
|
OP
|
$2,252.05
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
3507701201
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$306.11 |
| Max. Negotiated Rate |
$2,139.45 |
| Rate for Payer: Aetna of VT Commercial |
$2,139.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$997.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,355.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,914.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,824.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,013.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,790.38
|
| Rate for Payer: Cash Price |
$1,126.03
|
| Rate for Payer: Cash Price |
$1,126.03
|
| Rate for Payer: Cigna Commercial |
$1,801.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,801.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,801.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,013.42
|
| Rate for Payer: Multiplan Commercial |
$2,094.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,914.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,013.42
|
| Rate for Payer: United Healthcare Commercial |
$2,139.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,013.42
|
| Rate for Payer: United Healthcare VA CCN |
$1,013.42
|
|
|
CT GUIDANCE NEEDLE PLACEMENT
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 77012 26
|
| Hospital Charge Code |
9727701201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna of VT Commercial |
$202.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.40
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.05
|
| Rate for Payer: United Healthcare Commercial |
$202.35
|
|
|
CT GUIDANCE NEEDLE PLACEMENT
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 77012 26
|
| Hospital Charge Code |
9727701201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna of VT Commercial |
$202.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$181.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.34
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.85
|
| Rate for Payer: Multiplan Commercial |
$198.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$181.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.85
|
| Rate for Payer: United Healthcare Commercial |
$202.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.85
|
| Rate for Payer: United Healthcare VA CCN |
$95.85
|
|
