|
X-RAY XM UPR GI TRC 2CNTRST
|
Facility
|
IP
|
$1,559.27
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,154.02 |
| Max. Negotiated Rate |
$1,481.31 |
| Rate for Payer: Aetna of VT Commercial |
$1,481.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,154.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,154.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,325.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,309.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,247.42
|
| Rate for Payer: Cash Price |
$779.64
|
| Rate for Payer: Cigna Commercial |
$1,247.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,247.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,247.42
|
| Rate for Payer: Multiplan Commercial |
$1,450.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,325.38
|
| Rate for Payer: United Healthcare Commercial |
$1,481.31
|
|
|
X-RAY XM UPR GI TRC 2CNTRST
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
9727424601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.95 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
|
|
X-RAY XM UPR GI TRC 2CNTRST
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9727424601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
X-RAY XM UPR GI TRC 2CNTRST
|
Facility
|
OP
|
$1,559.27
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$420.26 |
| Max. Negotiated Rate |
$1,481.31 |
| Rate for Payer: Aetna of VT Commercial |
$1,481.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$690.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$938.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,325.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,263.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$701.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,239.62
|
| Rate for Payer: Cash Price |
$779.64
|
| Rate for Payer: Cash Price |
$779.64
|
| Rate for Payer: Cigna Commercial |
$1,247.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,247.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,247.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$701.67
|
| Rate for Payer: Multiplan Commercial |
$1,450.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,325.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$701.67
|
| Rate for Payer: United Healthcare Commercial |
$1,481.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$701.67
|
| Rate for Payer: United Healthcare VA CCN |
$701.67
|
|
|
X-RAY XM UPR GI TRC 2CNTRST
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
9727424601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.14
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare VA CCN |
$58.95
|
|
|
XR BONE AGE STUDIES
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 77072 26
|
| Hospital Charge Code |
9727707201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.20
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
|
|
XR BONE AGE STUDIES
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 77072 26
|
| Hospital Charge Code |
9727707201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna of VT Commercial |
$84.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.75
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.05
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.05
|
| Rate for Payer: United Healthcare VA CCN |
$40.05
|
|
|
XR BONE AGE STUDIES
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 77072 26
|
| Hospital Charge Code |
9727707201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna of VT Commercial |
$83.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.34
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$82.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$13.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare VA CCN |
$8.56
|
|
|
XR BONE AGE STUDIES
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
3207707201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$272.29 |
| Rate for Payer: Aetna of VT Commercial |
$272.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$126.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$227.86
|
| Rate for Payer: Cash Price |
$143.31
|
| Rate for Payer: Cash Price |
$143.31
|
| Rate for Payer: Cigna Commercial |
$229.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.98
|
| Rate for Payer: Multiplan Commercial |
$266.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$128.98
|
| Rate for Payer: United Healthcare Commercial |
$272.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.98
|
| Rate for Payer: United Healthcare VA CCN |
$128.98
|
|
|
XR BONE AGE STUDIES
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
3207707201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$272.29 |
| Rate for Payer: Aetna of VT Commercial |
$272.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$240.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.30
|
| Rate for Payer: Cash Price |
$143.31
|
| Rate for Payer: Cigna Commercial |
$229.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$266.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.63
|
| Rate for Payer: United Healthcare Commercial |
$272.29
|
|
|
XR BONE LENGTH STUDIES
|
Facility
|
IP
|
$444.02
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
3207707301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$421.82 |
| Rate for Payer: Aetna of VT Commercial |
$421.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$328.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$328.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$372.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.22
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cigna Commercial |
$355.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$355.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$355.22
|
| Rate for Payer: Multiplan Commercial |
$412.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.42
|
| Rate for Payer: United Healthcare Commercial |
$421.82
|
|
|
XR BONE LENGTH STUDIES
|
Facility
|
OP
|
$444.02
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
3207707301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.97 |
| Max. Negotiated Rate |
$421.82 |
| Rate for Payer: Aetna of VT Commercial |
$421.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$377.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$359.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$353.00
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cigna Commercial |
$355.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$355.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$355.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$199.81
|
| Rate for Payer: Multiplan Commercial |
$412.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$199.81
|
| Rate for Payer: United Healthcare Commercial |
$421.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.81
|
| Rate for Payer: United Healthcare VA CCN |
$199.81
|
|
|
XR BONE LENGTH STUDIES
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 77073 26
|
| Hospital Charge Code |
9727707301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
|
|
XR BONE LENGTH STUDIES
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 77073 26
|
| Hospital Charge Code |
9727707301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare VA CCN |
$58.50
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
32073650LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.36
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.75
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare VA CCN |
$197.75
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
32073650RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
32073650RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.36
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.75
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare VA CCN |
$197.75
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 73650 26
|
| Hospital Charge Code |
9727365001
|
|
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 CALCANEUS MIN 2 VIEWS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
CPT 73650 26
|
| Hospital Charge Code |
9727365001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$94.94 |
| Rate for Payer: Aetna of VT Commercial |
$94.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| 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 |
$90.86
|
| 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 |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.39
|
| 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 |
$11.39
|
| 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 CALCANEUS MIN 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
32073650LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 73650 26
|
| Hospital Charge Code |
9727365001
|
|
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
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
IP
|
$459.10
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3207365001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.78 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.28
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
|
|
XR CALCANEUS MIN 2 VIEWS
|
Facility
|
OP
|
$459.10
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3207365001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$203.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$276.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$371.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$206.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.98
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$206.59
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare VA CCN |
$206.59
|
|
|
XR CHEST 1 VIEW
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 71045 26
|
| Hospital Charge Code |
9727104501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare VA CCN |
$33.30
|
|
|
XR CHEST 1 VIEW
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 71045 26
|
| Hospital Charge Code |
9727104501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.20
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
|
