|
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
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
3527370001
|
|
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
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
CPT 73700 LT
|
| Hospital Charge Code |
35273700LT
|
|
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
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 73700 26
|
| Hospital Charge Code |
9727370001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 73700 26
|
| Hospital Charge Code |
9727370001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| 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 |
$45.92
|
| 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 |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.80
|
| 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 |
$70.80
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$70.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| 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
|
|
|
CT LOWER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
3527370001
|
|
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
|
$144.00
|
|
|
Service Code
|
CPT 73700 26
|
| Hospital Charge Code |
9727370001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$2,681.16
|
|
|
Service Code
|
CPT 73702 RT
|
| Hospital Charge Code |
35273702RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,984.33 |
| Max. Negotiated Rate |
$2,547.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,547.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,984.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,984.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,252.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,144.93
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cigna Commercial |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,144.93
|
| Rate for Payer: Multiplan Commercial |
$2,493.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,278.99
|
| Rate for Payer: United Healthcare Commercial |
$2,547.10
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$2,681.16
|
|
|
Service Code
|
CPT 73702 RT
|
| Hospital Charge Code |
35273702RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$622.37 |
| Max. Negotiated Rate |
$2,547.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,547.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,187.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,614.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,171.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,206.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,131.52
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cigna Commercial |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,144.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,206.52
|
| Rate for Payer: Multiplan Commercial |
$2,493.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,278.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,206.52
|
| Rate for Payer: United Healthcare Commercial |
$2,547.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,206.52
|
| Rate for Payer: United Healthcare VA CCN |
$1,206.52
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 73702 26
|
| Hospital Charge Code |
9727370201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$622.37 |
| Rate for Payer: Aetna of VT Commercial |
$164.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.14
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$85.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.11
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.11
|
| Rate for Payer: United Healthcare Commercial |
$83.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.11
|
| Rate for Payer: United Healthcare VA CCN |
$54.11
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 73702 26
|
| Hospital Charge Code |
9727370201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 73702 26
|
| Hospital Charge Code |
9727370201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.51 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna of VT Commercial |
$166.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.12
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$166.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.75
|
| Rate for Payer: United Healthcare VA CCN |
$78.75
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$2,681.16
|
|
|
Service Code
|
CPT 73702 LT
|
| Hospital Charge Code |
35273702LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,984.33 |
| Max. Negotiated Rate |
$2,547.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,547.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,984.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,984.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,252.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,144.93
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cigna Commercial |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,144.93
|
| Rate for Payer: Multiplan Commercial |
$2,493.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,278.99
|
| Rate for Payer: United Healthcare Commercial |
$2,547.10
|
|
|
CT LOWER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$2,681.16
|
|
|
Service Code
|
CPT 73702 LT
|
| Hospital Charge Code |
35273702LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$622.37 |
| Max. Negotiated Rate |
$2,547.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,547.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,187.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$622.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,614.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,171.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,206.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,131.52
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cash Price |
$1,340.58
|
| Rate for Payer: Cigna Commercial |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,144.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,144.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,206.52
|
| Rate for Payer: Multiplan Commercial |
$2,493.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,278.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,206.52
|
| Rate for Payer: United Healthcare Commercial |
$2,547.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,206.52
|
| Rate for Payer: United Healthcare VA CCN |
$1,206.52
|
|
|
CT LUMBAR SPINE W/CONTRAST
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 72132 26
|
| Hospital Charge Code |
9727213201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
CT LUMBAR SPINE W/CONTRAST
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 72132 26
|
| Hospital Charge Code |
9727213201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$503.86 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.86
|
| 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 |
$503.86
|
| 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 |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$85.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.43
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| 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 LUMBAR SPINE W/CONTRAST
|
Facility
|
IP
|
$2,583.19
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,911.82 |
| Max. Negotiated Rate |
$2,454.03 |
| Rate for Payer: Aetna of VT Commercial |
$2,454.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,911.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,911.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,195.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,169.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,066.55
|
| Rate for Payer: Cash Price |
$1,291.60
|
| Rate for Payer: Cigna Commercial |
$2,066.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,066.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,066.55
|
| Rate for Payer: Multiplan Commercial |
$2,402.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,195.71
|
| Rate for Payer: United Healthcare Commercial |
$2,454.03
|
|
|
CT LUMBAR SPINE W/CONTRAST
|
Facility
|
OP
|
$2,583.19
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$503.86 |
| Max. Negotiated Rate |
$2,454.03 |
| Rate for Payer: Aetna of VT Commercial |
$2,454.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,144.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,555.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,195.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,092.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,162.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,053.64
|
| Rate for Payer: Cash Price |
$1,291.60
|
| Rate for Payer: Cash Price |
$1,291.60
|
| Rate for Payer: Cigna Commercial |
$2,066.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,066.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,066.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,162.44
|
| Rate for Payer: Multiplan Commercial |
$2,402.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,195.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,162.44
|
| Rate for Payer: United Healthcare Commercial |
$2,454.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,162.44
|
| Rate for Payer: United Healthcare VA CCN |
$1,162.44
|
|
|
CT LUMBAR SPINE W/CONTRAST
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 72132 26
|
| Hospital Charge Code |
9727213201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,055.59
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$371.14 |
| Max. Negotiated Rate |
$1,952.81 |
| Rate for Payer: Aetna of VT Commercial |
$1,952.81
|
| 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 |
$910.42
|
| 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 |
$1,237.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,747.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,665.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,634.19
|
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cigna Commercial |
$1,644.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,644.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,644.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$925.02
|
| Rate for Payer: Multiplan Commercial |
$1,911.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,747.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$925.02
|
| Rate for Payer: United Healthcare Commercial |
$1,952.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$925.02
|
| Rate for Payer: United Healthcare VA CCN |
$925.02
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,055.59
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,521.34 |
| Max. Negotiated Rate |
$1,952.81 |
| Rate for Payer: Aetna of VT Commercial |
$1,952.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,521.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,521.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,747.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,726.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,644.47
|
| Rate for Payer: Cash Price |
$1,027.80
|
| Rate for Payer: Cigna Commercial |
$1,644.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,644.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,644.47
|
| Rate for Payer: Multiplan Commercial |
$1,911.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,747.25
|
| Rate for Payer: United Healthcare Commercial |
$1,952.81
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 72131 26
|
| Hospital Charge Code |
9727213101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$371.14 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| 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 |
$45.92
|
| 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 |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.72
|
| 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 |
$74.72
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$70.13
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| 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
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 72131 26
|
| Hospital Charge Code |
9727213101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.57 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
CT LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 72131 26
|
| Hospital Charge Code |
9727213101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of VT Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.48
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.80
|
| Rate for Payer: United Healthcare VA CCN |
$64.80
|
|
|
CT LUMBAR SPINE W/O & W/CONTR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 72133 26
|
| Hospital Charge Code |
9727213301
|
|
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
|
|
