|
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 HEAD/BRAIN W/CONTRAST
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 70460 26
|
| Hospital Charge Code |
9727046001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$150.98 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna of VT Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.20
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.20
|
| Rate for Payer: Multiplan Commercial |
$189.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.40
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
|
|
CT HEAD/BRAIN W/CONTRAST
|
Facility
|
IP
|
$2,213.02
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,637.86 |
| Max. Negotiated Rate |
$2,102.37 |
| Rate for Payer: Aetna of VT Commercial |
$2,102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,637.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,637.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,881.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,858.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,770.42
|
| Rate for Payer: Cash Price |
$1,106.51
|
| Rate for Payer: Cigna Commercial |
$1,770.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,770.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,770.42
|
| Rate for Payer: Multiplan Commercial |
$2,058.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,881.07
|
| Rate for Payer: United Healthcare Commercial |
$2,102.37
|
|
|
CT HEAD/BRAIN W/CONTRAST
|
Facility
|
OP
|
$2,213.02
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$428.93 |
| Max. Negotiated Rate |
$2,102.37 |
| Rate for Payer: Aetna of VT Commercial |
$2,102.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$428.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$980.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$428.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,332.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,881.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,792.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$995.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,759.35
|
| Rate for Payer: Cash Price |
$1,106.51
|
| Rate for Payer: Cash Price |
$1,106.51
|
| Rate for Payer: Cigna Commercial |
$1,770.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,770.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,770.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$995.86
|
| Rate for Payer: Multiplan Commercial |
$2,058.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,881.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$995.86
|
| Rate for Payer: United Healthcare Commercial |
$2,102.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$995.86
|
| Rate for Payer: United Healthcare VA CCN |
$995.86
|
|
|
CT HEAD/BRAIN W/CONTRAST
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 70460 26
|
| Hospital Charge Code |
9727046001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna of VT Commercial |
$191.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$428.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$428.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.59
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$79.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$189.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.56
|
| Rate for Payer: United Healthcare Commercial |
$77.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.56
|
| Rate for Payer: United Healthcare VA CCN |
$50.56
|
|
|
CT HEAD/BRAIN W/CONTRAST
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 70460 26
|
| Hospital Charge Code |
9727046001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna of VT Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.18
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.80
|
| Rate for Payer: Multiplan Commercial |
$189.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.80
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.80
|
| Rate for Payer: United Healthcare VA CCN |
$91.80
|
|
|
CT HEAD/BRAIN W/O CONTRAST
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 70450 26
|
| Hospital Charge Code |
9727045001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.20
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
|
|
CT HEAD/BRAIN W/O CONTRAST
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 70450 26
|
| Hospital Charge Code |
9727045001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna of VT Commercial |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$130.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.43
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$130.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$146.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.30
|
| Rate for Payer: United Healthcare VA CCN |
$69.30
|
|
|
CT HEAD/BRAIN W/O CONTRAST
|
Facility
|
OP
|
$1,697.83
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$1,612.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$751.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,022.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,443.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,375.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$764.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,349.77
|
| Rate for Payer: Cash Price |
$848.92
|
| Rate for Payer: Cash Price |
$848.92
|
| Rate for Payer: Cigna Commercial |
$1,358.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,358.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,358.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$764.02
|
| Rate for Payer: Multiplan Commercial |
$1,578.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,443.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$764.02
|
| Rate for Payer: United Healthcare Commercial |
$1,612.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$764.02
|
| Rate for Payer: United Healthcare VA CCN |
$764.02
|
|
|
CT HEAD/BRAIN W/O CONTRAST
|
Facility
|
IP
|
$1,697.83
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,256.56 |
| Max. Negotiated Rate |
$1,612.94 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,256.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,256.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,443.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,426.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,358.26
|
| Rate for Payer: Cash Price |
$848.92
|
| Rate for Payer: Cigna Commercial |
$1,358.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,358.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,358.26
|
| Rate for Payer: Multiplan Commercial |
$1,578.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,443.16
|
| Rate for Payer: United Healthcare Commercial |
$1,612.94
|
|
|
CT HEAD/BRAIN W/O CONTRAST
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 70450 26
|
| Hospital Charge Code |
9727045001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$298.90 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.02
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$59.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.13
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.12
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.12
|
| Rate for Payer: United Healthcare Commercial |
$58.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.12
|
| Rate for Payer: United Healthcare VA CCN |
$38.12
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST
|
Facility
|
OP
|
$2,536.40
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$512.57 |
| Max. Negotiated Rate |
$2,409.58 |
| Rate for Payer: Aetna of VT Commercial |
$2,409.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$512.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$512.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,526.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,155.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,054.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,141.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,016.44
|
| Rate for Payer: Cash Price |
$1,268.20
|
| Rate for Payer: Cash Price |
$1,268.20
|
| Rate for Payer: Cigna Commercial |
$2,029.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,029.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,029.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,141.38
|
| Rate for Payer: Multiplan Commercial |
$2,358.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,155.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,141.38
|
| Rate for Payer: United Healthcare Commercial |
$2,409.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,141.38
|
| Rate for Payer: United Healthcare VA CCN |
$1,141.38
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST
|
Facility
|
IP
|
$2,536.40
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,877.19 |
| Max. Negotiated Rate |
$2,409.58 |
| Rate for Payer: Aetna of VT Commercial |
$2,409.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,877.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,877.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,155.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,029.12
|
| Rate for Payer: Cash Price |
$1,268.20
|
| Rate for Payer: Cigna Commercial |
$2,029.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,029.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,029.12
|
| Rate for Payer: Multiplan Commercial |
$2,358.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,155.94
|
| Rate for Payer: United Healthcare Commercial |
$2,409.58
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 70470 26
|
| Hospital Charge Code |
9727047001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.20
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 70470 26
|
| Hospital Charge Code |
9727047001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$512.57 |
| Rate for Payer: Aetna of VT Commercial |
$215.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$512.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$512.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.27
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$89.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.86
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.86
|
| Rate for Payer: United Healthcare Commercial |
$87.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.86
|
| Rate for Payer: United Healthcare VA CCN |
$56.86
|
|
|
CT HEAD/BRAIN W/O & W/CONTRAST
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 70470 26
|
| Hospital Charge Code |
9727047001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$101.42 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.06
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.05
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare VA CCN |
$103.05
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 73701 26
|
| Hospital Charge Code |
9727370101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna of VT Commercial |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$149.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$100.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.76
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$133.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.15
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.15
|
| Rate for Payer: United Healthcare Commercial |
$158.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.15
|
| Rate for Payer: United Healthcare VA CCN |
$75.15
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,654.28
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
35273701LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,964.43 |
| Max. Negotiated Rate |
$2,521.57 |
| Rate for Payer: Aetna of VT Commercial |
$2,521.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,964.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,964.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,229.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,123.42
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cigna Commercial |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,123.42
|
| Rate for Payer: Multiplan Commercial |
$2,468.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,256.14
|
| Rate for Payer: United Healthcare Commercial |
$2,521.57
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,654.28
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
35273701RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,964.43 |
| Max. Negotiated Rate |
$2,521.57 |
| Rate for Payer: Aetna of VT Commercial |
$2,521.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,964.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,964.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,229.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,123.42
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cigna Commercial |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,123.42
|
| Rate for Payer: Multiplan Commercial |
$2,468.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,256.14
|
| Rate for Payer: United Healthcare Commercial |
$2,521.57
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,654.28
|
|
|
Service Code
|
CPT 73701 LT
|
| Hospital Charge Code |
35273701LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$505.31 |
| Max. Negotiated Rate |
$2,521.57 |
| Rate for Payer: Aetna of VT Commercial |
$2,521.57
|
| 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 |
$1,175.58
|
| 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 |
$1,597.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,149.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,194.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,110.15
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cigna Commercial |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,123.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,194.43
|
| Rate for Payer: Multiplan Commercial |
$2,468.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,256.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,194.43
|
| Rate for Payer: United Healthcare Commercial |
$2,521.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,194.43
|
| Rate for Payer: United Healthcare VA CCN |
$1,194.43
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 73701 26
|
| Hospital Charge Code |
9727370101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$505.31 |
| Rate for Payer: Aetna of VT Commercial |
$156.98
|
| 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 |
$53.41
|
| 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 |
$72.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.77
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$81.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.85
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.85
|
| Rate for Payer: United Healthcare Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.85
|
| Rate for Payer: United Healthcare VA CCN |
$51.85
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 73701 26
|
| Hospital Charge Code |
9727370101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna of VT Commercial |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.60
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.95
|
| Rate for Payer: United Healthcare Commercial |
$158.65
|
|
|
CT LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,654.28
|
|
|
Service Code
|
CPT 73701 RT
|
| Hospital Charge Code |
35273701RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$505.31 |
| Max. Negotiated Rate |
$2,521.57 |
| Rate for Payer: Aetna of VT Commercial |
$2,521.57
|
| 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 |
$1,175.58
|
| 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 |
$1,597.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,256.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,149.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,194.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,110.15
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cash Price |
$1,327.14
|
| Rate for Payer: Cigna Commercial |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,123.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,123.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,194.43
|
| Rate for Payer: Multiplan Commercial |
$2,468.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,256.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,194.43
|
| Rate for Payer: United Healthcare Commercial |
$2,521.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,194.43
|
| Rate for Payer: United Healthcare VA CCN |
$1,194.43
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
35273700RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,762.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,762.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$821.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,116.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,576.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,502.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$834.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,474.72
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,484.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,484.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$834.75
|
| Rate for Payer: Multiplan Commercial |
$1,725.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,576.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$834.75
|
| Rate for Payer: United Healthcare Commercial |
$1,762.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$834.75
|
| Rate for Payer: United Healthcare VA CCN |
$834.75
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
CPT 73700 RT
|
| Hospital Charge Code |
35273700RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,372.89 |
| Max. Negotiated Rate |
$1,762.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,762.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,372.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,372.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,576.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,558.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,484.00
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,484.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,484.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,576.75
|
| Rate for Payer: United Healthcare Commercial |
$1,762.25
|
|
