|
XR CHEST 1 VIEW
|
Facility
|
OP
|
$341.22
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
3207104501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$324.16 |
| Rate for Payer: Aetna of VT Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$205.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.27
|
| Rate for Payer: Cash Price |
$170.61
|
| Rate for Payer: Cash Price |
$170.61
|
| Rate for Payer: Cigna Commercial |
$272.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.55
|
| Rate for Payer: Multiplan Commercial |
$317.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.55
|
| Rate for Payer: United Healthcare Commercial |
$324.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.55
|
| Rate for Payer: United Healthcare VA CCN |
$153.55
|
|
|
XR CHEST 1 VIEW
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 71045 26
|
| Hospital Charge Code |
9727104501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$74.94 |
| Rate for Payer: Aetna of VT Commercial |
$69.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.94
|
| 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 |
$74.94
|
| 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 |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.08
|
| 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 |
$13.08
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$12.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| 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 CHEST 1 VIEW
|
Facility
|
IP
|
$341.22
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
3207104501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.54 |
| Max. Negotiated Rate |
$324.16 |
| Rate for Payer: Aetna of VT Commercial |
$324.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$286.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.98
|
| Rate for Payer: Cash Price |
$170.61
|
| Rate for Payer: Cigna Commercial |
$272.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.98
|
| Rate for Payer: Multiplan Commercial |
$317.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.04
|
| Rate for Payer: United Healthcare Commercial |
$324.16
|
|
|
XR CHEST 2 VIEWS
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 71046 26
|
| Hospital Charge Code |
9727104601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$100.97 |
| Rate for Payer: Aetna of VT Commercial |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.64
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$14.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.85
|
| Rate for Payer: United Healthcare VA CCN |
$9.85
|
|
|
XR CHEST 2 VIEWS
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 71046 26
|
| Hospital Charge Code |
9727104601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.20
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
|
|
XR CHEST 2 VIEWS
|
Facility
|
OP
|
$453.93
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
3207104601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.97 |
| Max. Negotiated Rate |
$431.23 |
| Rate for Payer: Aetna of VT Commercial |
$431.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$201.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$273.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$385.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$360.87
|
| Rate for Payer: Cash Price |
$226.96
|
| Rate for Payer: Cash Price |
$226.96
|
| Rate for Payer: Cigna Commercial |
$363.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.27
|
| Rate for Payer: Multiplan Commercial |
$422.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$204.27
|
| Rate for Payer: United Healthcare Commercial |
$431.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.27
|
| Rate for Payer: United Healthcare VA CCN |
$204.27
|
|
|
XR CHEST 2 VIEWS
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 71046 26
|
| Hospital Charge Code |
9727104601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.80
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare VA CCN |
$35.55
|
|
|
XR CHEST 2 VIEWS
|
Professional
|
Both
|
$453.93
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
3207104601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$426.69 |
| Rate for Payer: Aetna of VT Commercial |
$426.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.73
|
| Rate for Payer: Cash Price |
$226.96
|
| Rate for Payer: Cash Price |
$226.96
|
| Rate for Payer: Cigna Commercial |
$48.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.18
|
| Rate for Payer: Multiplan Commercial |
$422.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.18
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.18
|
| Rate for Payer: United Healthcare VA CCN |
$32.18
|
|
|
XR CHEST 2 VIEWS
|
Facility
|
IP
|
$453.93
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
3207104601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.95 |
| Max. Negotiated Rate |
$431.23 |
| Rate for Payer: Aetna of VT Commercial |
$431.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$335.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$335.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$385.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$363.14
|
| Rate for Payer: Cash Price |
$226.96
|
| Rate for Payer: Cigna Commercial |
$363.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.14
|
| Rate for Payer: Multiplan Commercial |
$422.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.84
|
| Rate for Payer: United Healthcare Commercial |
$431.23
|
|
|
XR CHEST 3 VIEWS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 71047 26
|
| Hospital Charge Code |
9727104701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.43 |
| 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 |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.69
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$18.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.44
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.43
|
| Rate for Payer: United Healthcare Commercial |
$19.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.43
|
| Rate for Payer: United Healthcare VA CCN |
$12.43
|
|
|
XR CHEST 3 VIEWS
|
Facility
|
IP
|
$424.88
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
3207104701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.45 |
| Max. Negotiated Rate |
$403.64 |
| Rate for Payer: Aetna of VT Commercial |
$403.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$356.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.90
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cigna Commercial |
$339.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$339.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$339.90
|
| Rate for Payer: Multiplan Commercial |
$395.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.15
|
| Rate for Payer: United Healthcare Commercial |
$403.64
|
|
|
XR CHEST 3 VIEWS
|
Facility
|
OP
|
$424.88
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
3207104701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$403.64 |
| Rate for Payer: Aetna of VT Commercial |
$403.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.78
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cigna Commercial |
$339.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$339.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$339.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$395.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.20
|
| Rate for Payer: United Healthcare Commercial |
$403.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.20
|
| Rate for Payer: United Healthcare VA CCN |
$191.20
|
|
|
XR CHEST 3 VIEWS
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 71047 26
|
| Hospital Charge Code |
9727104701
|
|
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 CHEST 3 VIEWS
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 71047 26
|
| Hospital Charge Code |
9727104701
|
|
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 CHOLANG&PANCREAT NTRAOP S&R
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 74300 26
|
| Hospital Charge Code |
9727430001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.53
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare VA CCN |
$77.85
|
|
|
XR CHOLANG&PANCREAT NTRAOP S&R
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 74300 26
|
| Hospital Charge Code |
9727430001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.54
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$18.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.28
|
| Rate for Payer: United Healthcare Commercial |
$18.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.28
|
| Rate for Payer: United Healthcare VA CCN |
$12.28
|
|
|
XR CHOLANG&PANCREAT NTRAOP S&R
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 74300 26
|
| Hospital Charge Code |
9727430001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
XR CHOLANG&PANCREAT NTRAOP S&R
|
Facility
|
IP
|
$1,494.39
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
3207430001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,106.00 |
| Max. Negotiated Rate |
$1,419.67 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,106.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,270.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,255.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,195.51
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cigna Commercial |
$1,195.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.51
|
| Rate for Payer: Multiplan Commercial |
$1,389.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.23
|
| Rate for Payer: United Healthcare Commercial |
$1,419.67
|
|
|
XR CHOLANG&PANCREAT NTRAOP S&R
|
Facility
|
OP
|
$1,494.39
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
3207430001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.67 |
| Max. Negotiated Rate |
$1,419.67 |
| Rate for Payer: Aetna of VT Commercial |
$1,419.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$661.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$899.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,270.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,210.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$672.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,188.04
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cigna Commercial |
$1,195.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,195.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,195.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$672.48
|
| Rate for Payer: Multiplan Commercial |
$1,389.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$672.48
|
| Rate for Payer: United Healthcare Commercial |
$1,419.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.48
|
| Rate for Payer: United Healthcare VA CCN |
$672.48
|
|
|
XR CLAVICLE COMPLETE
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
CPT 73000 26
|
| Hospital Charge Code |
9727300001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$106.73 |
| Rate for Payer: Aetna of VT Commercial |
$61.10
|
| 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 |
$7.82
|
| 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 |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.13
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$11.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare VA CCN |
$7.59
|
|
|
XR CLAVICLE COMPLETE
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
3207300001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.73 |
| Max. Negotiated Rate |
$418.46 |
| Rate for Payer: Aetna of VT Commercial |
$418.46
|
| 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 |
$195.09
|
| 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 |
$265.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$356.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.18
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cigna Commercial |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.22
|
| Rate for Payer: Multiplan Commercial |
$409.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.22
|
| Rate for Payer: United Healthcare Commercial |
$418.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.22
|
| Rate for Payer: United Healthcare VA CCN |
$198.22
|
|
|
XR CLAVICLE COMPLETE
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
3207300001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$418.46 |
| Rate for Payer: Aetna of VT Commercial |
$418.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.38
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cigna Commercial |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.38
|
| Rate for Payer: Multiplan Commercial |
$409.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.41
|
| Rate for Payer: United Healthcare Commercial |
$418.46
|
|
|
XR CLAVICLE COMPLETE
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
32073000LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$418.46 |
| Rate for Payer: Aetna of VT Commercial |
$418.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.38
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cigna Commercial |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.38
|
| Rate for Payer: Multiplan Commercial |
$409.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.41
|
| Rate for Payer: United Healthcare Commercial |
$418.46
|
|
|
XR CLAVICLE COMPLETE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 73000 26
|
| Hospital Charge Code |
9727300001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.67
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare VA CCN |
$29.25
|
|
|
XR CLAVICLE COMPLETE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 73000 26
|
| Hospital Charge Code |
9727300001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
|
