|
CT SOFT TISSUE NECK W/O &W/DYE
|
Facility
|
OP
|
$2,790.77
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3507049201
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$655.57 |
| Max. Negotiated Rate |
$2,651.23 |
| Rate for Payer: Aetna of VT Commercial |
$2,651.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,236.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,680.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,372.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,260.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,218.66
|
| Rate for Payer: Cash Price |
$1,395.38
|
| Rate for Payer: Cash Price |
$1,395.38
|
| Rate for Payer: Cigna Commercial |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,232.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,255.85
|
| Rate for Payer: Multiplan Commercial |
$2,595.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,372.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,255.85
|
| Rate for Payer: United Healthcare Commercial |
$2,651.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,255.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,255.85
|
|
|
CT THORACIC SPINE W/CONTRAST
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 72129 26
|
| Hospital Charge Code |
9727212901
|
|
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 THORACIC SPINE W/CONTRAST
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 72129 26
|
| Hospital Charge Code |
9727212901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$506.77 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$506.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$506.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.79
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$85.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$83.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.60
|
| Rate for Payer: United Healthcare VA CCN |
$54.60
|
|
|
CT THORACIC SPINE W/CONTRAST
|
Facility
|
IP
|
$1,206.55
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
3527212901
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$892.97 |
| Max. Negotiated Rate |
$1,146.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,146.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$892.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$892.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,025.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,013.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$965.24
|
| Rate for Payer: Cash Price |
$603.28
|
| Rate for Payer: Cigna Commercial |
$965.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$965.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$965.24
|
| Rate for Payer: Multiplan Commercial |
$1,122.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,025.57
|
| Rate for Payer: United Healthcare Commercial |
$1,146.22
|
|
|
CT THORACIC SPINE W/CONTRAST
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 72129 26
|
| Hospital Charge Code |
9727212901
|
|
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 THORACIC SPINE W/CONTRAST
|
Facility
|
OP
|
$1,206.55
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
3527212901
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$506.77 |
| Max. Negotiated Rate |
$1,146.22 |
| Rate for Payer: Aetna of VT Commercial |
$1,146.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$506.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$534.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$506.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,025.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$977.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$542.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$959.21
|
| Rate for Payer: Cash Price |
$603.28
|
| Rate for Payer: Cash Price |
$603.28
|
| Rate for Payer: Cigna Commercial |
$965.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$965.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$965.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$542.95
|
| Rate for Payer: Multiplan Commercial |
$1,122.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,025.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$542.95
|
| Rate for Payer: United Healthcare Commercial |
$1,146.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$542.95
|
| Rate for Payer: United Healthcare VA CCN |
$542.95
|
|
|
CT THORACIC SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,282.04
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
3527212801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$2,167.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,167.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$374.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,010.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$374.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,373.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,939.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,848.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,026.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,814.22
|
| Rate for Payer: Cash Price |
$1,141.02
|
| Rate for Payer: Cash Price |
$1,141.02
|
| Rate for Payer: Cigna Commercial |
$1,825.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,825.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,825.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,026.92
|
| Rate for Payer: Multiplan Commercial |
$2,122.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,939.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,026.92
|
| Rate for Payer: United Healthcare Commercial |
$2,167.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.92
|
| Rate for Payer: United Healthcare VA CCN |
$1,026.92
|
|
|
CT THORACIC SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,282.04
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
3527212801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,688.94 |
| Max. Negotiated Rate |
$2,167.94 |
| Rate for Payer: Aetna of VT Commercial |
$2,167.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,688.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,688.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,939.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,916.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,825.63
|
| Rate for Payer: Cash Price |
$1,141.02
|
| Rate for Payer: Cigna Commercial |
$1,825.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,825.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,825.63
|
| Rate for Payer: Multiplan Commercial |
$2,122.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,939.73
|
| Rate for Payer: United Healthcare Commercial |
$2,167.94
|
|
|
CT THORACIC SPINE W/O CONTRAST
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 72128 26
|
| Hospital Charge Code |
9727212801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$374.05 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$374.05
|
| 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 |
$374.05
|
| 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 THORACIC SPINE W/O CONTRAST
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 72128 26
|
| Hospital Charge Code |
9727212801
|
|
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 THORACIC SPINE W/O CONTRAST
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 72128 26
|
| Hospital Charge Code |
9727212801
|
|
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 THORACIC SPINE W/O &W/CONTR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 72130 26
|
| Hospital Charge Code |
9727213001
|
|
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 THORACIC SPINE W/O &W/CONTR
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 72130 26
|
| Hospital Charge Code |
9727213001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$625.23 |
| Rate for Payer: Aetna of VT Commercial |
$172.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$625.23
|
| 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 |
$625.23
|
| 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 |
$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 |
$65.39
|
| 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 |
$89.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.86
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| 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 THORACIC SPINE W/O &W/CONTR
|
Facility
|
IP
|
$3,475.89
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
3527213001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,572.51 |
| Max. Negotiated Rate |
$3,302.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,302.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,572.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,572.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,954.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,919.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,780.71
|
| Rate for Payer: Cash Price |
$1,737.94
|
| Rate for Payer: Cigna Commercial |
$2,780.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,780.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,780.71
|
| Rate for Payer: Multiplan Commercial |
$3,232.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,954.51
|
| Rate for Payer: United Healthcare Commercial |
$3,302.10
|
|
|
CT THORACIC SPINE W/O &W/CONTR
|
Facility
|
OP
|
$3,475.89
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
3527213001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$625.23 |
| Max. Negotiated Rate |
$3,302.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,302.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$625.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,539.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$625.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,092.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,954.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,815.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,564.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,763.33
|
| Rate for Payer: Cash Price |
$1,737.94
|
| Rate for Payer: Cash Price |
$1,737.94
|
| Rate for Payer: Cigna Commercial |
$2,780.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,780.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,780.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,564.15
|
| Rate for Payer: Multiplan Commercial |
$3,232.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,954.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,564.15
|
| Rate for Payer: United Healthcare Commercial |
$3,302.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,564.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,564.15
|
|
|
CT THORACIC SPINE W/O &W/CONTR
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 72130 26
|
| Hospital Charge Code |
9727213001
|
|
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 THORAX LUNG CA SCR W/O DYE
|
Facility
|
OP
|
$1,150.58
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
3527127101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$391.16 |
| Max. Negotiated Rate |
$1,093.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,093.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$509.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$692.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$931.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$517.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$914.71
|
| Rate for Payer: Cash Price |
$575.29
|
| Rate for Payer: Cash Price |
$575.29
|
| Rate for Payer: Cigna Commercial |
$920.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$920.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$920.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$517.76
|
| Rate for Payer: Multiplan Commercial |
$1,070.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$977.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$517.76
|
| Rate for Payer: United Healthcare Commercial |
$1,093.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$517.76
|
| Rate for Payer: United Healthcare VA CCN |
$517.76
|
|
|
CT THORAX LUNG CA SCR W/O DYE
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 71271 26
|
| Hospital Charge Code |
9727127101
|
|
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 THORAX LUNG CA SCR W/O DYE
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 71271 26
|
| Hospital Charge Code |
9727127101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$391.16 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.16
|
| 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 |
$391.16
|
| 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 |
$67.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.42
|
| 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 |
$67.42
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| 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 THORAX LUNG CA SCR W/O DYE
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 71271 26
|
| Hospital Charge Code |
9727127101
|
|
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 THORAX LUNG CA SCR W/O DYE
|
Facility
|
IP
|
$1,150.58
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
3527127101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$851.54 |
| Max. Negotiated Rate |
$1,093.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,093.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$851.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$851.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$977.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$966.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$920.46
|
| Rate for Payer: Cash Price |
$575.29
|
| Rate for Payer: Cigna Commercial |
$920.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$920.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$920.46
|
| Rate for Payer: Multiplan Commercial |
$1,070.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$977.99
|
| Rate for Payer: United Healthcare Commercial |
$1,093.05
|
|
|
CT UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,864.44
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
35273201LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,119.97 |
| Max. Negotiated Rate |
$2,721.22 |
| Rate for Payer: Aetna of VT Commercial |
$2,721.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,119.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,119.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,434.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,406.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,291.55
|
| Rate for Payer: Cash Price |
$1,432.22
|
| Rate for Payer: Cigna Commercial |
$2,291.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,291.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,291.55
|
| Rate for Payer: Multiplan Commercial |
$2,663.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,434.77
|
| Rate for Payer: United Healthcare Commercial |
$2,721.22
|
|
|
CT UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 73201 26
|
| Hospital Charge Code |
9727320101
|
|
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 UPPER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 73201 26
|
| Hospital Charge Code |
9727320101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$657.02 |
| Rate for Payer: Aetna of VT Commercial |
$156.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$657.02
|
| 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 |
$657.02
|
| 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 UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$2,864.44
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
35273201RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,119.97 |
| Max. Negotiated Rate |
$2,721.22 |
| Rate for Payer: Aetna of VT Commercial |
$2,721.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,119.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,119.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,434.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,406.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,291.55
|
| Rate for Payer: Cash Price |
$1,432.22
|
| Rate for Payer: Cigna Commercial |
$2,291.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,291.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,291.55
|
| Rate for Payer: Multiplan Commercial |
$2,663.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,434.77
|
| Rate for Payer: United Healthcare Commercial |
$2,721.22
|
|
