|
XR HIP UNILAT W PELVIS 1 VIEW
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
32073501RT
|
|
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
|
IP
|
$204.73
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
32073501RT
|
|
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 2-3 VWS
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
32073502RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.79 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna of VT Commercial |
$475.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$420.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.80
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.80
|
| Rate for Payer: Multiplan Commercial |
$465.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.85
|
| Rate for Payer: United Healthcare Commercial |
$475.95
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 73502 26
|
| Hospital Charge Code |
9727350201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 73502 26
|
| Hospital Charge Code |
9727350201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.11
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.65
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare VA CCN |
$43.65
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
32073502LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.79 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna of VT Commercial |
$475.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$420.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.80
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.80
|
| Rate for Payer: Multiplan Commercial |
$465.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.85
|
| Rate for Payer: United Healthcare Commercial |
$475.95
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
32073502RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna of VT Commercial |
$475.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$301.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$225.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.30
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.45
|
| Rate for Payer: Multiplan Commercial |
$465.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$225.45
|
| Rate for Payer: United Healthcare Commercial |
$475.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.45
|
| Rate for Payer: United Healthcare VA CCN |
$225.45
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 73502 26
|
| Hospital Charge Code |
9727350201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of VT Commercial |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.20
|
| 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 |
$160.20
|
| 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 |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$15.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| 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 HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
32073502LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna of VT Commercial |
$475.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$221.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$301.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$425.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$225.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$398.30
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.45
|
| Rate for Payer: Multiplan Commercial |
$465.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$225.45
|
| Rate for Payer: United Healthcare Commercial |
$475.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.45
|
| Rate for Payer: United Healthcare VA CCN |
$225.45
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
IP
|
$485.98
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
3207350201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.67 |
| Max. Negotiated Rate |
$461.68 |
| Rate for Payer: Aetna of VT Commercial |
$461.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$359.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$359.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.78
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cigna Commercial |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.78
|
| Rate for Payer: Multiplan Commercial |
$451.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.08
|
| Rate for Payer: United Healthcare Commercial |
$461.68
|
|
|
XR HIP UNILAT W PELVIS 2-3 VWS
|
Facility
|
OP
|
$485.98
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
3207350201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$461.68 |
| Rate for Payer: Aetna of VT Commercial |
$461.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$215.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$292.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.35
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cash Price |
$242.99
|
| Rate for Payer: Cigna Commercial |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.69
|
| Rate for Payer: Multiplan Commercial |
$451.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$413.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.69
|
| Rate for Payer: United Healthcare Commercial |
$461.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.69
|
| Rate for Payer: United Healthcare VA CCN |
$218.69
|
|
|
XR HUMERUS MIN 2 VIEWS
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 73060 26
|
| Hospital Charge Code |
9727306001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna of VT Commercial |
$59.22
|
| 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 |
$7.49
|
| 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 |
$10.18
|
| 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 |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.33
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare VA CCN |
$7.27
|
|
|
XR HUMERUS MIN 2 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73060 LT
|
| Hospital Charge Code |
32073060LT
|
|
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 HUMERUS MIN 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
3207306001
|
|
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 HUMERUS MIN 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73060 LT
|
| Hospital Charge Code |
32073060LT
|
|
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 HUMERUS MIN 2 VIEWS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 73060 26
|
| Hospital Charge Code |
9727306001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna of VT Commercial |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.09
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.35
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.35
|
| Rate for Payer: United Healthcare Commercial |
$59.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.35
|
| Rate for Payer: United Healthcare VA CCN |
$28.35
|
|
|
XR HUMERUS MIN 2 VIEWS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 73060 26
|
| Hospital Charge Code |
9727306001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna of VT Commercial |
$59.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$58.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.55
|
| Rate for Payer: United Healthcare Commercial |
$59.85
|
|
|
XR HUMERUS MIN 2 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73060 RT
|
| Hospital Charge Code |
32073060RT
|
|
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 HUMERUS MIN 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73060 RT
|
| Hospital Charge Code |
32073060RT
|
|
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 HUMERUS MIN 2 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
3207306001
|
|
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 JAW JOINT BILAT
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 70330 26
|
| Hospital Charge Code |
9727033001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$180.43 |
| Rate for Payer: Aetna of VT Commercial |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.24
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$16.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.82
|
| Rate for Payer: United Healthcare Commercial |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.82
|
| Rate for Payer: United Healthcare VA CCN |
$10.82
|
|
|
XR JAW JOINT BILAT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 70330 26
|
| Hospital Charge Code |
9727033001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.80
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
|
|
XR JAW JOINT BILAT
|
Facility
|
IP
|
$668.87
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
3207033001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$495.03 |
| Max. Negotiated Rate |
$635.43 |
| Rate for Payer: Aetna of VT Commercial |
$635.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$495.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$495.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$568.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$535.10
|
| Rate for Payer: Cash Price |
$334.44
|
| Rate for Payer: Cigna Commercial |
$535.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.10
|
| Rate for Payer: Multiplan Commercial |
$622.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$568.54
|
| Rate for Payer: United Healthcare Commercial |
$635.43
|
|
|
XR JAW JOINT BILAT
|
Facility
|
OP
|
$668.87
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
3207033001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.43 |
| Max. Negotiated Rate |
$635.43 |
| Rate for Payer: Aetna of VT Commercial |
$635.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$296.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$402.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$568.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$300.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.75
|
| Rate for Payer: Cash Price |
$334.44
|
| Rate for Payer: Cash Price |
$334.44
|
| Rate for Payer: Cigna Commercial |
$535.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.99
|
| Rate for Payer: Multiplan Commercial |
$622.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$568.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$300.99
|
| Rate for Payer: United Healthcare Commercial |
$635.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.99
|
| Rate for Payer: United Healthcare VA CCN |
$300.99
|
|
|
XR JAW JOINT BILAT
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 70330 26
|
| Hospital Charge Code |
9727033001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna of VT Commercial |
$133.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.09
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.45
|
| Rate for Payer: Multiplan Commercial |
$131.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare Commercial |
$133.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.45
|
| Rate for Payer: United Healthcare VA CCN |
$63.45
|
|
