|
XR EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 70030 26
|
| Hospital Charge Code |
9727003001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna of VT Commercial |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.20
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.15
|
| Rate for Payer: United Healthcare Commercial |
$94.05
|
|
|
XR EYE FOR FOREIGN BODY
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
CPT 70030 26
|
| Hospital Charge Code |
9727003001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna of VT Commercial |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.28
|
| 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 |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.14
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$12.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$8.24
|
|
|
XR EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
3207003001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.28 |
| 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 |
$105.28
|
| 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 |
$105.28
|
| 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 EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 70030 26
|
| Hospital Charge Code |
9727003001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna of VT Commercial |
$94.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.70
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare Commercial |
$94.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare VA CCN |
$44.55
|
|
|
XR FACIAL BONES <3 VIEWS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 70140 26
|
| Hospital Charge Code |
9727014001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna of VT Commercial |
$96.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.92
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$13.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.20
|
| Rate for Payer: United Healthcare Commercial |
$14.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.20
|
| Rate for Payer: United Healthcare VA CCN |
$9.20
|
|
|
XR FACIAL BONES <3 VIEWS
|
Facility
|
OP
|
$471.50
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
3207014001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$447.93 |
| Rate for Payer: Aetna of VT Commercial |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$98.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$98.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.84
|
| Rate for Payer: Cash Price |
$235.75
|
| Rate for Payer: Cash Price |
$235.75
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$377.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$377.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.18
|
| Rate for Payer: Multiplan Commercial |
$438.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.18
|
| Rate for Payer: United Healthcare Commercial |
$447.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.18
|
| Rate for Payer: United Healthcare VA CCN |
$212.18
|
|
|
XR FACIAL BONES <3 VIEWS
|
Facility
|
IP
|
$471.50
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
3207014001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.96 |
| Max. Negotiated Rate |
$447.93 |
| Rate for Payer: Aetna of VT Commercial |
$447.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$377.20
|
| Rate for Payer: Cash Price |
$235.75
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$377.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$377.20
|
| Rate for Payer: Multiplan Commercial |
$438.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.77
|
| Rate for Payer: United Healthcare Commercial |
$447.93
|
|
|
XR FACIAL BONES <3 VIEWS
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 70140 26
|
| Hospital Charge Code |
9727014001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna of VT Commercial |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.40
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.55
|
| Rate for Payer: United Healthcare Commercial |
$97.85
|
|
|
XR FACIAL BONES <3 VIEWS
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 70140 26
|
| Hospital Charge Code |
9727014001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna of VT Commercial |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.89
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.35
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare Commercial |
$97.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare VA CCN |
$46.35
|
|
|
XR FACIAL BONES MIN 3 VIEWS
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 70150 26
|
| Hospital Charge Code |
9727015001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna of VT Commercial |
$117.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.20
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.20
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.40
|
| Rate for Payer: United Healthcare Commercial |
$117.80
|
|
|
XR FACIAL BONES MIN 3 VIEWS
|
Facility
|
IP
|
$944.56
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
3207015001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$699.07 |
| Max. Negotiated Rate |
$897.33 |
| Rate for Payer: Aetna of VT Commercial |
$897.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$699.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$699.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$793.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.65
|
| Rate for Payer: Cash Price |
$472.28
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.65
|
| Rate for Payer: Multiplan Commercial |
$878.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.88
|
| Rate for Payer: United Healthcare Commercial |
$897.33
|
|
|
XR FACIAL BONES MIN 3 VIEWS
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 70150 26
|
| Hospital Charge Code |
9727015001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$151.54 |
| Rate for Payer: Aetna of VT Commercial |
$116.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.37
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$17.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.79
|
| Rate for Payer: United Healthcare Commercial |
$18.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.79
|
| Rate for Payer: United Healthcare VA CCN |
$11.79
|
|
|
XR FACIAL BONES MIN 3 VIEWS
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 70150 26
|
| Hospital Charge Code |
9727015001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna of VT Commercial |
$117.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.58
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.80
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.80
|
| Rate for Payer: United Healthcare Commercial |
$117.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.80
|
| Rate for Payer: United Healthcare VA CCN |
$55.80
|
|
|
XR FACIAL BONES MIN 3 VIEWS
|
Facility
|
OP
|
$944.56
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
3207015001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.54 |
| Max. Negotiated Rate |
$897.33 |
| Rate for Payer: Aetna of VT Commercial |
$897.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$418.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$568.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$765.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$425.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.93
|
| Rate for Payer: Cash Price |
$472.28
|
| Rate for Payer: Cash Price |
$472.28
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$425.05
|
| Rate for Payer: Multiplan Commercial |
$878.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$425.05
|
| Rate for Payer: United Healthcare Commercial |
$897.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.05
|
| Rate for Payer: United Healthcare VA CCN |
$425.05
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 73552 26
|
| Hospital Charge Code |
9727355201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$69.57 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna of VT Commercial |
$89.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.20
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$75.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$75.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$75.20
|
| Rate for Payer: Multiplan Commercial |
$87.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.90
|
| Rate for Payer: United Healthcare Commercial |
$89.30
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$606.96
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.21 |
| Max. Negotiated Rate |
$576.61 |
| Rate for Payer: Aetna of VT Commercial |
$576.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$449.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$449.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$515.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$509.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.57
|
| Rate for Payer: Cash Price |
$303.48
|
| Rate for Payer: Cigna Commercial |
$485.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$485.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$485.57
|
| Rate for Payer: Multiplan Commercial |
$564.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$515.92
|
| Rate for Payer: United Healthcare Commercial |
$576.61
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$397.51
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
32073552LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$377.63 |
| Rate for Payer: Aetna of VT Commercial |
$377.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.01
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cigna Commercial |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.01
|
| Rate for Payer: Multiplan Commercial |
$369.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.88
|
| Rate for Payer: United Healthcare Commercial |
$377.63
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$606.96
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$576.61 |
| Rate for Payer: Aetna of VT Commercial |
$576.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$268.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$365.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$515.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$491.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$273.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$482.53
|
| Rate for Payer: Cash Price |
$303.48
|
| Rate for Payer: Cash Price |
$303.48
|
| Rate for Payer: Cigna Commercial |
$485.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$485.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$485.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$273.13
|
| Rate for Payer: Multiplan Commercial |
$564.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$515.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$273.13
|
| Rate for Payer: United Healthcare Commercial |
$576.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.13
|
| Rate for Payer: United Healthcare VA CCN |
$273.13
|
|
|
XR FEMUR MIN 2 VIEWS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 73552 26
|
| Hospital Charge Code |
9727355201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$116.84 |
| Rate for Payer: Aetna of VT Commercial |
$88.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.84
|
| 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 |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.14
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$12.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$87.42
|
| 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 FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$397.51
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
32073552RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$377.63 |
| Rate for Payer: Aetna of VT Commercial |
$377.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$318.01
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cigna Commercial |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.01
|
| Rate for Payer: Multiplan Commercial |
$369.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.88
|
| Rate for Payer: United Healthcare Commercial |
$377.63
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$397.51
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
32073552RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$377.63 |
| Rate for Payer: Aetna of VT Commercial |
$377.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$239.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$316.02
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cigna Commercial |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$178.88
|
| Rate for Payer: Multiplan Commercial |
$369.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.88
|
| Rate for Payer: United Healthcare Commercial |
$377.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.88
|
| Rate for Payer: United Healthcare VA CCN |
$178.88
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 73552 26
|
| Hospital Charge Code |
9727355201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna of VT Commercial |
$89.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.73
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$75.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$75.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$75.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.30
|
| Rate for Payer: Multiplan Commercial |
$87.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.30
|
| Rate for Payer: United Healthcare Commercial |
$89.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.30
|
| Rate for Payer: United Healthcare VA CCN |
$42.30
|
|
|
XR FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$397.51
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
32073552LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$377.63 |
| Rate for Payer: Aetna of VT Commercial |
$377.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$176.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$239.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$337.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$316.02
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cash Price |
$198.76
|
| Rate for Payer: Cigna Commercial |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$178.88
|
| Rate for Payer: Multiplan Commercial |
$369.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$337.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$178.88
|
| Rate for Payer: United Healthcare Commercial |
$377.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.88
|
| Rate for Payer: United Healthcare VA CCN |
$178.88
|
|
|
XR FINGER MIN 2 VIEWS
|
Facility
|
IP
|
$459.10
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
3207314001
|
|
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 FINGER MIN 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
32073140RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.07 |
| 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 |
$137.07
|
| 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 |
$137.07
|
| 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
|
|
