|
XR CLAVICLE COMPLETE
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
32073000RT
|
|
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
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
32073000LT
|
|
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
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73000 50
|
| Hospital Charge Code |
3207300050
|
|
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 RT
|
| Hospital Charge Code |
32073000RT
|
|
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 50
|
| Hospital Charge Code |
3207300050
|
|
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 DXA BONE DENSITY AXIAL SKEL
|
Facility
|
IP
|
$738.28
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
3207708001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$546.40 |
| Max. Negotiated Rate |
$701.37 |
| Rate for Payer: Aetna of VT Commercial |
$701.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$546.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$546.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$627.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$620.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.62
|
| Rate for Payer: Cash Price |
$369.14
|
| Rate for Payer: Cigna Commercial |
$590.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$590.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$590.62
|
| Rate for Payer: Multiplan Commercial |
$686.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$627.54
|
| Rate for Payer: United Healthcare Commercial |
$701.37
|
|
|
XR DXA BONE DENSITY AXIAL SKEL
|
Facility
|
OP
|
$738.28
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
3207708001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$701.37 |
| Rate for Payer: Aetna of VT Commercial |
$701.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$326.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$444.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$627.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$598.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$332.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$586.93
|
| Rate for Payer: Cash Price |
$369.14
|
| Rate for Payer: Cash Price |
$369.14
|
| Rate for Payer: Cigna Commercial |
$590.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$590.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$590.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$332.23
|
| Rate for Payer: Multiplan Commercial |
$686.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$627.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$332.23
|
| Rate for Payer: United Healthcare Commercial |
$701.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.23
|
| Rate for Payer: United Healthcare VA CCN |
$332.23
|
|
|
XR DXA BONE DENSITY AXIAL SKEL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 77080 26
|
| Hospital Charge Code |
9727708001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna of VT Commercial |
$27.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.05
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$23.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$26.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$27.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare VA CCN |
$13.05
|
|
|
XR DXA BONE DENSITY AXIAL SKEL
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 77080 26
|
| Hospital Charge Code |
9727708001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$128.41 |
| Rate for Payer: Aetna of VT Commercial |
$27.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$26.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare VA CCN |
$8.89
|
|
|
XR DXA BONE DENSITY AXIAL SKEL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 77080 26
|
| Hospital Charge Code |
9727708001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna of VT Commercial |
$27.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.20
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna Commercial |
$23.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$26.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.65
|
| Rate for Payer: United Healthcare Commercial |
$27.55
|
|
|
XR DXA BONE DENSITY PERIPH SKL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
CPT 77081 26
|
| Hospital Charge Code |
9727708101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna of VT Commercial |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.45
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare VA CCN |
$8.89
|
|
|
XR DXA BONE DENSITY PERIPH SKL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 77081 26
|
| Hospital Charge Code |
9727708101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$86.59 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna of VT Commercial |
$111.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.60
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.45
|
| Rate for Payer: United Healthcare Commercial |
$111.15
|
|
|
XR DXA BONE DENSITY PERIPH SKL
|
Facility
|
OP
|
$392.92
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
3207708101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.62 |
| Max. Negotiated Rate |
$373.27 |
| Rate for Payer: Aetna of VT Commercial |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$236.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.37
|
| Rate for Payer: Cash Price |
$196.46
|
| Rate for Payer: Cash Price |
$196.46
|
| Rate for Payer: Cigna Commercial |
$314.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$176.81
|
| Rate for Payer: Multiplan Commercial |
$365.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.81
|
| Rate for Payer: United Healthcare Commercial |
$373.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.81
|
| Rate for Payer: United Healthcare VA CCN |
$176.81
|
|
|
XR DXA BONE DENSITY PERIPH SKL
|
Facility
|
IP
|
$392.92
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
3207708101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.80 |
| Max. Negotiated Rate |
$373.27 |
| Rate for Payer: Aetna of VT Commercial |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$333.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.34
|
| Rate for Payer: Cash Price |
$196.46
|
| Rate for Payer: Cigna Commercial |
$314.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.34
|
| Rate for Payer: Multiplan Commercial |
$365.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.98
|
| Rate for Payer: United Healthcare Commercial |
$373.27
|
|
|
XR DXA BONE DENSITY PERIPH SKL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 77081 26
|
| Hospital Charge Code |
9727708101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna of VT Commercial |
$111.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.02
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.65
|
| Rate for Payer: Multiplan Commercial |
$108.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.65
|
| Rate for Payer: United Healthcare Commercial |
$111.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.65
|
| Rate for Payer: United Healthcare VA CCN |
$52.65
|
|
|
XR DXA BONE DENSITY STUDY
|
Facility
|
IP
|
$965.76
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
3207708501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$714.76 |
| Max. Negotiated Rate |
$917.47 |
| Rate for Payer: Aetna of VT Commercial |
$917.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$714.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$714.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$820.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$811.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$772.61
|
| Rate for Payer: Cash Price |
$482.88
|
| Rate for Payer: Cigna Commercial |
$772.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$772.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$772.61
|
| Rate for Payer: Multiplan Commercial |
$898.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.90
|
| Rate for Payer: United Healthcare Commercial |
$917.47
|
|
|
XR DXA BONE DENSITY STUDY
|
Facility
|
OP
|
$965.76
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
3207708501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$917.47 |
| Rate for Payer: Aetna of VT Commercial |
$917.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$427.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$581.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$820.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$782.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$434.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$767.78
|
| Rate for Payer: Cash Price |
$482.88
|
| Rate for Payer: Cash Price |
$482.88
|
| Rate for Payer: Cigna Commercial |
$772.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$772.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$772.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.59
|
| Rate for Payer: Multiplan Commercial |
$898.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$820.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$434.59
|
| Rate for Payer: United Healthcare Commercial |
$917.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$434.59
|
| Rate for Payer: United Healthcare VA CCN |
$434.59
|
|
|
XR DXA BONE DENSITY STUDY
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 77085 26
|
| Hospital Charge Code |
9727708501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
XR DXA BONE DENSITY STUDY
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 77085 26
|
| Hospital Charge Code |
9727708501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
XR ELBOW 2 VIEWS
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 73070 26
|
| Hospital Charge Code |
9727307001
|
|
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 ELBOW 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
32073070LT
|
|
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 ELBOW 2 VIEWS
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 73070 26
|
| Hospital Charge Code |
9727307001
|
|
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 ELBOW 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73070 RT
|
| Hospital Charge Code |
32073070RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.26 |
| 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 |
$92.26
|
| 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 |
$92.26
|
| 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 ELBOW 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
3207307001
|
|
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 ELBOW 2 VIEWS
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 73070 26
|
| Hospital Charge Code |
9727307001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$92.26 |
| Rate for Payer: Aetna of VT Commercial |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.26
|
| 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 |
$92.26
|
| 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 |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| 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
|
|
