|
XR HAND MIN 3 VIEWS
|
Facility
|
OP
|
$529.41
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
3207313001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$502.94 |
| Rate for Payer: Aetna of VT Commercial |
$502.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$428.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$238.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$420.88
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cigna Commercial |
$423.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$423.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$423.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$238.23
|
| Rate for Payer: Multiplan Commercial |
$492.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$238.23
|
| Rate for Payer: United Healthcare Commercial |
$502.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.23
|
| Rate for Payer: United Healthcare VA CCN |
$238.23
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
IP
|
$521.55
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
32073130RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.24
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
IP
|
$529.41
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
3207313001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$391.82 |
| Max. Negotiated Rate |
$502.94 |
| Rate for Payer: Aetna of VT Commercial |
$502.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$444.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$423.53
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cigna Commercial |
$423.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$423.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$423.53
|
| Rate for Payer: Multiplan Commercial |
$492.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$450.00
|
| Rate for Payer: United Healthcare Commercial |
$502.94
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 73130 26
|
| Hospital Charge Code |
9727313001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.80
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
IP
|
$521.55
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
32073130LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.24
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
|
|
XR HAND MIN 3 VIEWS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
CPT 73130 26
|
| Hospital Charge Code |
9727313001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$125.51 |
| Rate for Payer: Aetna of VT Commercial |
$66.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.33
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$12.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.91
|
| Rate for Payer: United Healthcare Commercial |
$12.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.91
|
| Rate for Payer: United Healthcare VA CCN |
$7.91
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
OP
|
$521.55
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
32073130RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.63
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.70
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare VA CCN |
$234.70
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
OP
|
$521.55
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
32073130LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.63
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.70
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare VA CCN |
$234.70
|
|
|
XR HAND MIN 3 VIEWS
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 73130 26
|
| Hospital Charge Code |
9727313001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
XR HIPS BILAT W PELVIS 2 VIEWS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 73521 26
|
| Hospital Charge Code |
9727352101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
XR HIPS BILAT W PELVIS 2 VIEWS
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 73521 26
|
| Hospital Charge Code |
9727352101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$132.72 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.24
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$15.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare VA CCN |
$10.17
|
|
|
XR HIPS BILAT W PELVIS 2 VIEWS
|
Facility
|
IP
|
$643.71
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
3207352101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$476.41 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna of VT Commercial |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$476.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$476.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$547.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$540.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.97
|
| Rate for Payer: Cash Price |
$321.86
|
| Rate for Payer: Cigna Commercial |
$514.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.97
|
| Rate for Payer: Multiplan Commercial |
$598.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$547.15
|
| Rate for Payer: United Healthcare Commercial |
$611.52
|
|
|
XR HIPS BILAT W PELVIS 2 VIEWS
|
Facility
|
OP
|
$643.71
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
3207352101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna of VT Commercial |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$285.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$387.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$547.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$521.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$289.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$511.75
|
| Rate for Payer: Cash Price |
$321.86
|
| Rate for Payer: Cash Price |
$321.86
|
| Rate for Payer: Cigna Commercial |
$514.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$514.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$514.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$289.67
|
| Rate for Payer: Multiplan Commercial |
$598.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$547.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$289.67
|
| Rate for Payer: United Healthcare Commercial |
$611.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.67
|
| Rate for Payer: United Healthcare VA CCN |
$289.67
|
|
|
XR HIPS BILAT W PELVIS 2 VIEWS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 73521 26
|
| Hospital Charge Code |
9727352101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
XR HIPS BI W PELVIS 3-4 VIEWS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 73522 26
|
| Hospital Charge Code |
9727352201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.40
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
|
|
XR HIPS BI W PELVIS 3-4 VIEWS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 73522 26
|
| Hospital Charge Code |
9727352201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.59
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare VA CCN |
$73.35
|
|
|
XR HIPS BI W PELVIS 3-4 VIEWS
|
Facility
|
OP
|
$578.01
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
3207352201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$549.11 |
| Rate for Payer: Aetna of VT Commercial |
$549.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$347.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$468.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$459.52
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$462.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$462.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$462.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$260.10
|
| Rate for Payer: Multiplan Commercial |
$537.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$491.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$260.10
|
| Rate for Payer: United Healthcare Commercial |
$549.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.10
|
| Rate for Payer: United Healthcare VA CCN |
$260.10
|
|
|
XR HIPS BI W PELVIS 3-4 VIEWS
|
Facility
|
IP
|
$578.01
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
3207352201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$427.79 |
| Max. Negotiated Rate |
$549.11 |
| Rate for Payer: Aetna of VT Commercial |
$549.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$427.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$427.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$491.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$485.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$462.41
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$462.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$462.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$462.41
|
| Rate for Payer: Multiplan Commercial |
$537.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$491.31
|
| Rate for Payer: United Healthcare Commercial |
$549.11
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
CPT 73501 26
|
| Hospital Charge Code |
9727350101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.52
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$92.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$13.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare VA CCN |
$8.56
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
IP
|
$391.89
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
3207350101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.04 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Aetna of VT Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$333.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$329.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$313.51
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cigna Commercial |
$313.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$313.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$313.51
|
| Rate for Payer: Multiplan Commercial |
$364.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.11
|
| Rate for Payer: United Healthcare Commercial |
$372.30
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
IP
|
$204.73
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
32073501LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.78
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
32073501LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.67 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.76
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.13
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.13
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.13
|
| Rate for Payer: United Healthcare VA CCN |
$92.13
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
OP
|
$391.89
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
3207350101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Aetna of VT Commercial |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$333.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$317.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$176.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.55
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cigna Commercial |
$313.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$313.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$313.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$176.35
|
| Rate for Payer: Multiplan Commercial |
$364.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$333.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$176.35
|
| Rate for Payer: United Healthcare Commercial |
$372.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.35
|
| Rate for Payer: United Healthcare VA CCN |
$176.35
|
|
|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 73501 26
|
| Hospital Charge Code |
9727350101
|
|
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 HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 73501 26
|
| Hospital Charge Code |
9727350101
|
|
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
|
|
