|
CT UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,864.44
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
35273201LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$657.02 |
| 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 |
$657.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,268.66
|
| 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 |
$1,724.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,434.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,320.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,289.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,277.23
|
| Rate for Payer: Cash Price |
$1,432.22
|
| 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: Martins Point Health Care Commercial |
$1,289.00
|
| Rate for Payer: Multiplan Commercial |
$2,663.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,434.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,289.00
|
| Rate for Payer: United Healthcare Commercial |
$2,721.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,289.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,289.00
|
|
|
CT UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$2,864.44
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
35273201RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$657.02 |
| 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 |
$657.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,268.66
|
| 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 |
$1,724.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,434.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,320.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,289.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,277.23
|
| Rate for Payer: Cash Price |
$1,432.22
|
| 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: Martins Point Health Care Commercial |
$1,289.00
|
| Rate for Payer: Multiplan Commercial |
$2,663.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,434.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,289.00
|
| Rate for Payer: United Healthcare Commercial |
$2,721.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,289.00
|
| Rate for Payer: United Healthcare VA CCN |
$1,289.00
|
|
|
CT UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 73201 26
|
| Hospital Charge Code |
9727320101
|
|
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 UPPER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
3527320001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$462.17 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$763.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,037.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,396.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$775.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,370.16
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare VA CCN |
$775.56
|
|
|
CT UPPER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
35273200LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,275.54 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,447.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,378.78
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
|
|
CT UPPER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 73200 26
|
| Hospital Charge Code |
9727320001
|
|
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 UPPER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 73200 26
|
| Hospital Charge Code |
9727320001
|
|
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 UPPER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
35273200RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$462.17 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$763.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,037.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,396.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$775.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,370.16
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare VA CCN |
$775.56
|
|
|
CT UPPER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
35273200RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,275.54 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,447.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,378.78
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
|
|
CT UPPER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
35273200LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$462.17 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$763.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,037.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,396.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$775.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,370.16
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$775.56
|
| Rate for Payer: United Healthcare VA CCN |
$775.56
|
|
|
CT UPPER EXTREMITY W/O CONTR
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 73200 26
|
| Hospital Charge Code |
9727320001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$462.17 |
| Rate for Payer: Aetna of VT Commercial |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.17
|
| 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 |
$462.17
|
| 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 |
$77.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.56
|
| 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 |
$77.56
|
| 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 UPPER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$1,723.47
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
3527320001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,275.54 |
| Max. Negotiated Rate |
$1,637.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,637.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,275.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,464.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,447.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,378.78
|
| Rate for Payer: Cash Price |
$861.74
|
| Rate for Payer: Cigna Commercial |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,378.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,378.78
|
| Rate for Payer: Multiplan Commercial |
$1,602.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,464.95
|
| Rate for Payer: United Healthcare Commercial |
$1,637.30
|
|
|
CT UPPER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 73202 26
|
| Hospital Charge Code |
9727320201
|
|
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 UPPER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$3,090.83
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
35273202LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$2,936.29 |
| Rate for Payer: Aetna of VT Commercial |
$2,936.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,368.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,860.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,627.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,503.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,390.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,457.21
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cigna Commercial |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,472.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,390.87
|
| Rate for Payer: Multiplan Commercial |
$2,874.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,627.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,390.87
|
| Rate for Payer: United Healthcare Commercial |
$2,936.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,390.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,390.87
|
|
|
CT UPPER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 73202 26
|
| Hospital Charge Code |
9727320201
|
|
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 UPPER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$3,090.83
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
35273202RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,287.52 |
| Max. Negotiated Rate |
$2,936.29 |
| Rate for Payer: Aetna of VT Commercial |
$2,936.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,287.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,287.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,627.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,596.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,472.66
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cigna Commercial |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,472.66
|
| Rate for Payer: Multiplan Commercial |
$2,874.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,627.21
|
| Rate for Payer: United Healthcare Commercial |
$2,936.29
|
|
|
CT UPPER EXTREMITY W/O & W/DYE
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 73202 26
|
| Hospital Charge Code |
9727320201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$772.63 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| 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 |
$772.63
|
| 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 |
$90.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.41
|
| 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 |
$90.41
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$85.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.11
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| 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 UPPER EXTREMITY W/O & W/DYE
|
Facility
|
OP
|
$3,090.83
|
|
|
Service Code
|
CPT 73202 RT
|
| Hospital Charge Code |
35273202RT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$2,936.29 |
| Rate for Payer: Aetna of VT Commercial |
$2,936.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,368.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,860.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,627.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,503.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,390.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,457.21
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cigna Commercial |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,472.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,390.87
|
| Rate for Payer: Multiplan Commercial |
$2,874.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,627.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,390.87
|
| Rate for Payer: United Healthcare Commercial |
$2,936.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,390.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,390.87
|
|
|
CT UPPER EXTREMITY W/O & W/DYE
|
Facility
|
IP
|
$3,090.83
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
35273202LT
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,287.52 |
| Max. Negotiated Rate |
$2,936.29 |
| Rate for Payer: Aetna of VT Commercial |
$2,936.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,287.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,287.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,627.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,596.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,472.66
|
| Rate for Payer: Cash Price |
$1,545.41
|
| Rate for Payer: Cigna Commercial |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,472.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,472.66
|
| Rate for Payer: Multiplan Commercial |
$2,874.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,627.21
|
| Rate for Payer: United Healthcare Commercial |
$2,936.29
|
|
|
CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
OP
|
$187.99
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
3008707501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna of VT Commercial |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.45
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$150.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$174.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.60
|
| Rate for Payer: United Healthcare Commercial |
$178.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.47
|
| Rate for Payer: United Healthcare VA CCN |
$84.60
|
|
|
CULTR BACTERIA EXCEPT BLOOD
|
Facility
|
IP
|
$187.99
|
|
|
Service Code
|
CPT 87075
|
| Hospital Charge Code |
3008707501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.13 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna of VT Commercial |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.39
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$150.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.39
|
| Rate for Payer: Multiplan Commercial |
$174.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.79
|
| Rate for Payer: United Healthcare Commercial |
$178.59
|
|
|
CULTURE AEROBIC IDENTIFY
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
3008707701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.56
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
|
|
CULTURE AEROBIC IDENTIFY
|
Facility
|
OP
|
$74.45
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
300870770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.19
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare VA CCN |
$33.50
|
|
|
CULTURE AEROBIC IDENTIFY
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
300870770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.56
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
|
|
CULTURE AEROBIC IDENTIFY
|
Facility
|
OP
|
$74.45
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
3008707701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$70.73 |
| Rate for Payer: Aetna of VT Commercial |
$70.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.19
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$70.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare VA CCN |
$33.50
|
|
