|
ARTERY X-RAY ARM/LEG LE LT
|
Facility
|
OP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
32075710LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,690.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,657.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,733.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,829.43
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,733.64
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare VA CCN |
$2,733.64
|
|
|
ARTERY X-RAY ARM/LEG LE LT
|
Facility
|
IP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
32075710LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,495.92 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,102.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.80
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
|
|
ARTERY X-RAYS ARM/LEG
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
CPT 75710 26
|
| Hospital Charge Code |
9727571001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$298.73 |
| Rate for Payer: Aetna of VT Commercial |
$234.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.81
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$113.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.75
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.75
|
| Rate for Payer: United Healthcare Commercial |
$114.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.75
|
| Rate for Payer: United Healthcare VA CCN |
$74.75
|
|
|
ARTERY X-RAYS ARM/LEG
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 75710 26
|
| Hospital Charge Code |
9727571001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna of VT Commercial |
$236.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.20
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
|
|
ARTERY X-RAYS ARM/LEG
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 75710 26
|
| Hospital Charge Code |
9727571001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$110.28 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna of VT Commercial |
$236.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.96
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.05
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare VA CCN |
$112.05
|
|
|
ARTERY X-RAYS ARM/LEG LE RT
|
Facility
|
OP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
32075710RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,690.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,657.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,733.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,829.43
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,733.64
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare VA CCN |
$2,733.64
|
|
|
ARTERY X-RAYS ARM/LEG LE RT
|
Facility
|
IP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
32075710RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,495.92 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,102.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.80
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
|
|
ARTERY X-RAYS ARM/LEG UE LT
|
Facility
|
OP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
32075710UL
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,690.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,657.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,733.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,829.43
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,733.64
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare VA CCN |
$2,733.64
|
|
|
ARTERY X-RAYS ARM/LEG UE LT
|
Facility
|
IP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
32075710UL
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,495.92 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,102.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.80
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
|
|
ARTERY X-RAYS ARM/LEG UE RT
|
Facility
|
OP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
32075710UR
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,690.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,657.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,733.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,829.43
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,733.64
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,733.64
|
| Rate for Payer: United Healthcare VA CCN |
$2,733.64
|
|
|
ARTERY X-RAYS ARM/LEG UE RT
|
Facility
|
IP
|
$6,074.75
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
32075710UR
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,495.92 |
| Max. Negotiated Rate |
$5,771.01 |
| Rate for Payer: Aetna of VT Commercial |
$5,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,163.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,102.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.80
|
| Rate for Payer: Cash Price |
$3,037.38
|
| Rate for Payer: Cigna Commercial |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,859.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,859.80
|
| Rate for Payer: Multiplan Commercial |
$5,649.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,163.54
|
| Rate for Payer: United Healthcare Commercial |
$5,771.01
|
|
|
ARTERY X-RAYS ARMS/LEGS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 75716 26
|
| Hospital Charge Code |
9727571601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna of VT Commercial |
$261.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$246.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$165.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$222.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.62
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.75
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.75
|
| Rate for Payer: United Healthcare Commercial |
$261.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.75
|
| Rate for Payer: United Healthcare VA CCN |
$123.75
|
|
|
ARTERY X-RAYS ARMS/LEGS
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 75716 26
|
| Hospital Charge Code |
9727571601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$84.91 |
| Max. Negotiated Rate |
$311.70 |
| Rate for Payer: Aetna of VT Commercial |
$258.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.59
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$128.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.91
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.91
|
| Rate for Payer: United Healthcare Commercial |
$130.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.91
|
| Rate for Payer: United Healthcare VA CCN |
$84.91
|
|
|
ARTERY X-RAYS ARMS/LEGS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 75716 26
|
| Hospital Charge Code |
9727571601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$203.53 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna of VT Commercial |
$261.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$203.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$203.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$233.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$220.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$255.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$233.75
|
| Rate for Payer: United Healthcare Commercial |
$261.25
|
|
|
ARTERY X-RAYS ARMS/LEGS LE BI
|
Facility
|
OP
|
$6,412.35
|
|
|
Service Code
|
CPT 75716 50
|
| Hospital Charge Code |
3207571601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.70 |
| Max. Negotiated Rate |
$6,091.73 |
| Rate for Payer: Aetna of VT Commercial |
$6,091.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,840.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,860.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,194.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,885.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,097.82
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cigna Commercial |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,129.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,885.56
|
| Rate for Payer: Multiplan Commercial |
$5,963.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,450.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,885.56
|
| Rate for Payer: United Healthcare Commercial |
$6,091.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,885.56
|
| Rate for Payer: United Healthcare VA CCN |
$2,885.56
|
|
|
ARTERY X-RAYS ARMS/LEGS LE BI
|
Facility
|
IP
|
$6,412.35
|
|
|
Service Code
|
CPT 75716 50
|
| Hospital Charge Code |
3207571601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,745.78 |
| Max. Negotiated Rate |
$6,091.73 |
| Rate for Payer: Aetna of VT Commercial |
$6,091.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,745.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,745.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,386.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,129.88
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cigna Commercial |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,129.88
|
| Rate for Payer: Multiplan Commercial |
$5,963.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,450.50
|
| Rate for Payer: United Healthcare Commercial |
$6,091.73
|
|
|
ARTERY X-RAYS ARMS/LEGS UE BI
|
Facility
|
OP
|
$6,412.35
|
|
|
Service Code
|
CPT 75716 50
|
| Hospital Charge Code |
3207571602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.70 |
| Max. Negotiated Rate |
$6,091.73 |
| Rate for Payer: Aetna of VT Commercial |
$6,091.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,840.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,860.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,194.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,885.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,097.82
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cigna Commercial |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,129.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,885.56
|
| Rate for Payer: Multiplan Commercial |
$5,963.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,450.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,885.56
|
| Rate for Payer: United Healthcare Commercial |
$6,091.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,885.56
|
| Rate for Payer: United Healthcare VA CCN |
$2,885.56
|
|
|
ARTERY X-RAYS ARMS/LEGS UE BI
|
Facility
|
IP
|
$6,412.35
|
|
|
Service Code
|
CPT 75716 50
|
| Hospital Charge Code |
3207571602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,745.78 |
| Max. Negotiated Rate |
$6,091.73 |
| Rate for Payer: Aetna of VT Commercial |
$6,091.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,745.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,745.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,450.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,386.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,129.88
|
| Rate for Payer: Cash Price |
$3,206.18
|
| Rate for Payer: Cigna Commercial |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,129.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,129.88
|
| Rate for Payer: Multiplan Commercial |
$5,963.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,450.50
|
| Rate for Payer: United Healthcare Commercial |
$6,091.73
|
|
|
ARTHRD ANT NTRBD CERVICAL EA
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
CPT 22552
|
| Hospital Charge Code |
9822255201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$351.45 |
| Max. Negotiated Rate |
$826.26 |
| Rate for Payer: Aetna of VT Commercial |
$826.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$361.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$492.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$467.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$404.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$467.76
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$667.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$612.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$612.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$351.45
|
| Rate for Payer: Multiplan Commercial |
$817.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$499.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$351.45
|
| Rate for Payer: United Healthcare Commercial |
$540.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$351.45
|
| Rate for Payer: United Healthcare VA CCN |
$351.45
|
|
|
ARTHRD ANT NTRBD CERVICAL EA
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 22552
|
| Hospital Charge Code |
9822255201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$650.55 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Aetna of VT Commercial |
$835.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$650.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$650.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$747.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$738.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$703.20
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$703.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$703.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$703.20
|
| Rate for Payer: Multiplan Commercial |
$817.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$747.15
|
| Rate for Payer: United Healthcare Commercial |
$835.05
|
|
|
ARTHRD ANT NTRBD CERVICAL EA
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 22552
|
| Hospital Charge Code |
9822255201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Aetna of VT Commercial |
$835.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$389.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$529.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$747.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$395.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$698.80
|
| Rate for Payer: Cash Price |
$439.50
|
| Rate for Payer: Cigna Commercial |
$703.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$703.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$703.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$395.55
|
| Rate for Payer: Multiplan Commercial |
$817.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$747.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$395.55
|
| Rate for Payer: United Healthcare Commercial |
$835.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$395.55
|
| Rate for Payer: United Healthcare VA CCN |
$395.55
|
|
|
ARTHRD ANT NTRBDY CERVICAL
|
Professional
|
Both
|
$3,829.00
|
|
|
Service Code
|
CPT 22551
|
| Hospital Charge Code |
9822255101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,541.72 |
| Max. Negotiated Rate |
$3,599.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,599.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,587.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,158.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,127.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,127.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,772.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,127.42
|
| Rate for Payer: Cash Price |
$1,914.50
|
| Rate for Payer: Cash Price |
$1,914.50
|
| Rate for Payer: Cigna Commercial |
$2,927.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,661.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,661.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,541.72
|
| Rate for Payer: Multiplan Commercial |
$3,560.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,189.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,541.72
|
| Rate for Payer: United Healthcare Commercial |
$2,371.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,541.72
|
| Rate for Payer: United Healthcare VA CCN |
$1,541.72
|
|
|
ARTHRD ANT NTRBDY CERVICAL
|
Facility
|
OP
|
$3,829.00
|
|
|
Service Code
|
CPT 22551
|
| Hospital Charge Code |
9822255101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,695.86 |
| Max. Negotiated Rate |
$3,637.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,637.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,695.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,430.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,305.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,254.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,101.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,723.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,044.05
|
| Rate for Payer: Cash Price |
$1,914.50
|
| Rate for Payer: Cigna Commercial |
$3,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,063.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,723.05
|
| Rate for Payer: Multiplan Commercial |
$3,560.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,254.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,723.05
|
| Rate for Payer: United Healthcare Commercial |
$3,637.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,723.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,723.05
|
|
|
ARTHRD ANT NTRBDY CERVICAL
|
Facility
|
IP
|
$3,829.00
|
|
|
Service Code
|
CPT 22551
|
| Hospital Charge Code |
9822255101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,833.84 |
| Max. Negotiated Rate |
$3,637.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,637.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,833.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,833.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,254.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,216.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,063.20
|
| Rate for Payer: Cash Price |
$1,914.50
|
| Rate for Payer: Cigna Commercial |
$3,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,063.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,063.20
|
| Rate for Payer: Multiplan Commercial |
$3,560.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,254.65
|
| Rate for Payer: United Healthcare Commercial |
$3,637.55
|
|
|
ARTHREX AMNION MATRIX 4X6
|
Facility
|
IP
|
$3,127.85
|
|
| Hospital Charge Code |
2780064351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,314.92 |
| Max. Negotiated Rate |
$2,971.46 |
| Rate for Payer: Aetna of VT Commercial |
$2,971.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,314.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,314.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,658.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,627.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,502.28
|
| Rate for Payer: Cash Price |
$1,563.92
|
| Rate for Payer: Cigna Commercial |
$2,502.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,502.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,502.28
|
| Rate for Payer: Multiplan Commercial |
$2,908.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,658.67
|
| Rate for Payer: United Healthcare Commercial |
$2,971.46
|
|
