|
X Linked Adrenoleukadystophy F
|
Facility
|
OP
|
$1,066.05
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
3008140501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$1,484.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,012.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,484.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$472.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,484.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$906.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$863.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$479.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$847.51
|
| Rate for Payer: Cash Price |
$533.02
|
| Rate for Payer: Cash Price |
$533.02
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$852.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$852.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$479.72
|
| Rate for Payer: Multiplan Commercial |
$991.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$906.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$479.72
|
| Rate for Payer: United Healthcare Commercial |
$1,012.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.35
|
| Rate for Payer: United Healthcare VA CCN |
$479.72
|
|
|
X Linked Adrenoleukadystophy F
|
Facility
|
IP
|
$1,066.05
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
3008140501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$788.98 |
| Max. Negotiated Rate |
$1,012.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,012.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$788.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$788.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$906.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$895.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$852.84
|
| Rate for Payer: Cash Price |
$533.02
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$852.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$852.84
|
| Rate for Payer: Multiplan Commercial |
$991.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$906.14
|
| Rate for Payer: United Healthcare Commercial |
$1,012.75
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$432.21
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
3207401801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.88 |
| Max. Negotiated Rate |
$410.60 |
| Rate for Payer: Aetna of VT Commercial |
$410.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$319.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$319.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.77
|
| Rate for Payer: Cash Price |
$216.10
|
| Rate for Payer: Cigna Commercial |
$345.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.77
|
| Rate for Payer: Multiplan Commercial |
$401.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$367.38
|
| Rate for Payer: United Healthcare Commercial |
$410.60
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 74018 26
|
| Hospital Charge Code |
9727401801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna of VT Commercial |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.20
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.15
|
| Rate for Payer: United Healthcare Commercial |
$94.05
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$432.21
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
3207401801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$410.60 |
| Rate for Payer: Aetna of VT Commercial |
$410.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$367.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$350.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$343.61
|
| Rate for Payer: Cash Price |
$216.10
|
| Rate for Payer: Cash Price |
$216.10
|
| Rate for Payer: Cigna Commercial |
$345.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.49
|
| Rate for Payer: Multiplan Commercial |
$401.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$367.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.49
|
| Rate for Payer: United Healthcare Commercial |
$410.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.49
|
| Rate for Payer: United Healthcare VA CCN |
$194.49
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 74018 26
|
| Hospital Charge Code |
9727401801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna of VT Commercial |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.70
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare Commercial |
$94.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare VA CCN |
$44.55
|
|
|
XR ABDOMEN 1 VIEW
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
CPT 74018 26
|
| Hospital Charge Code |
9727401801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$93.71 |
| Rate for Payer: Aetna of VT Commercial |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.14
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$12.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$8.24
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 74019 26
|
| Hospital Charge Code |
9727401901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.96
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare VA CCN |
$39.60
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$477.71
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$453.82 |
| Rate for Payer: Aetna of VT Commercial |
$453.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$211.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$287.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$406.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$386.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.78
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cigna Commercial |
$382.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$382.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$382.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.97
|
| Rate for Payer: Multiplan Commercial |
$444.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$406.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.97
|
| Rate for Payer: United Healthcare Commercial |
$453.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.97
|
| Rate for Payer: United Healthcare VA CCN |
$214.97
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 74019 26
|
| Hospital Charge Code |
9727401901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
|
|
XR ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 74019 26
|
| Hospital Charge Code |
9727401901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$112.49 |
| Rate for Payer: Aetna of VT Commercial |
$82.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$16.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.50
|
| Rate for Payer: United Healthcare VA CCN |
$10.50
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$477.71
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.55 |
| Max. Negotiated Rate |
$453.82 |
| Rate for Payer: Aetna of VT Commercial |
$453.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$353.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$353.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$406.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$401.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$382.17
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cigna Commercial |
$382.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$382.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$382.17
|
| Rate for Payer: Multiplan Commercial |
$444.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$406.05
|
| Rate for Payer: United Healthcare Commercial |
$453.82
|
|
|
XR ABDOMEN 3/> VIEWS
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 74021 26
|
| Hospital Charge Code |
9727402101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
XR ABDOMEN 3/> VIEWS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 74021 26
|
| Hospital Charge Code |
9727402101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.48
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$18.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare VA CCN |
$12.11
|
|
|
XR ABDOMEN 3/> VIEWS
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 74021 26
|
| Hospital Charge Code |
9727402101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
XR ABDOMEN 3/> VIEWS
|
Facility
|
OP
|
$701.83
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$666.74 |
| Rate for Payer: Aetna of VT Commercial |
$666.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$310.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$422.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$568.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$315.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$557.95
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cigna Commercial |
$561.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.82
|
| Rate for Payer: Multiplan Commercial |
$652.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$315.82
|
| Rate for Payer: United Healthcare Commercial |
$666.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.82
|
| Rate for Payer: United Healthcare VA CCN |
$315.82
|
|
|
XR ABDOMEN 3/> VIEWS
|
Facility
|
IP
|
$701.83
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.42 |
| Max. Negotiated Rate |
$666.74 |
| Rate for Payer: Aetna of VT Commercial |
$666.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$596.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$589.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$561.46
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cigna Commercial |
$561.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$561.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$561.46
|
| Rate for Payer: Multiplan Commercial |
$652.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$596.56
|
| Rate for Payer: United Healthcare Commercial |
$666.74
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
IP
|
$367.07
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
32073600RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.67 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.66
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
|
|
XR ANKLE 2 VIEWS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
CPT 73600 26
|
| Hospital Charge Code |
9727360001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$106.73 |
| Rate for Payer: Aetna of VT Commercial |
$94.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.59
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$93.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare VA CCN |
$7.27
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 73600 26
|
| Hospital Charge Code |
9727360001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Aetna of VT Commercial |
$95.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.30
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$80.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.45
|
| Rate for Payer: Multiplan Commercial |
$93.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.45
|
| Rate for Payer: United Healthcare Commercial |
$95.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.45
|
| Rate for Payer: United Healthcare VA CCN |
$45.45
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$449.79
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
3207360001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$427.30 |
| Rate for Payer: Aetna of VT Commercial |
$427.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$382.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$357.58
|
| Rate for Payer: Cash Price |
$224.90
|
| Rate for Payer: Cash Price |
$224.90
|
| Rate for Payer: Cigna Commercial |
$359.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.41
|
| Rate for Payer: Multiplan Commercial |
$418.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$382.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.41
|
| Rate for Payer: United Healthcare Commercial |
$427.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.41
|
| Rate for Payer: United Healthcare VA CCN |
$202.41
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
IP
|
$367.07
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
32073600LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.67 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.66
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$367.07
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
32073600LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.82
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.18
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare VA CCN |
$165.18
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$367.07
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
32073600RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.82
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.18
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare VA CCN |
$165.18
|
|
|
XR ANKLE 2 VIEWS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 73600 26
|
| Hospital Charge Code |
9727360001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Aetna of VT Commercial |
$95.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.80
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$80.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$93.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.85
|
| Rate for Payer: United Healthcare Commercial |
$95.95
|
|
