|
XR OSSEOUS SURVERY COMPL
|
Facility
|
OP
|
$972.99
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
3207707501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$318.95 |
| Max. Negotiated Rate |
$924.34 |
| Rate for Payer: Aetna of VT Commercial |
$924.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$585.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$827.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$788.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$437.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$773.53
|
| Rate for Payer: Cash Price |
$486.50
|
| Rate for Payer: Cash Price |
$486.50
|
| Rate for Payer: Cigna Commercial |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$778.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$778.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$437.85
|
| Rate for Payer: Multiplan Commercial |
$904.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$827.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$437.85
|
| Rate for Payer: United Healthcare Commercial |
$924.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.85
|
| Rate for Payer: United Healthcare VA CCN |
$437.85
|
|
|
XR OSSEOUS SURVERY COMPL
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 77075 26
|
| Hospital Charge Code |
9727707501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$193.17 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.80
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
|
|
XR OSSEOUS SURVERY COMPL
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 77075 26
|
| Hospital Charge Code |
9727707501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna of VT Commercial |
$247.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$211.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.45
|
| Rate for Payer: Multiplan Commercial |
$242.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.45
|
| Rate for Payer: United Healthcare VA CCN |
$117.45
|
|
|
XR PELVIS 1/2 VIEWS
|
Facility
|
IP
|
$411.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
3207217001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$390.71 |
| Rate for Payer: Aetna of VT Commercial |
$390.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$329.02
|
| Rate for Payer: Cash Price |
$205.64
|
| Rate for Payer: Cigna Commercial |
$329.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$329.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$329.02
|
| Rate for Payer: Multiplan Commercial |
$382.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.58
|
| Rate for Payer: United Healthcare Commercial |
$390.71
|
|
|
XR PELVIS 1/2 VIEWS
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 72170 26
|
| Hospital Charge Code |
9727217001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$57.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$103.35
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.50
|
| Rate for Payer: United Healthcare VA CCN |
$58.50
|
|
|
XR PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 72170 26
|
| Hospital Charge Code |
9727217001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna of VT Commercial |
$122.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.05
|
| 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 |
$85.05
|
| 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 |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.22
|
| 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 |
$13.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$12.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| 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 PELVIS 1/2 VIEWS
|
Facility
|
OP
|
$411.27
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
3207217001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$390.71 |
| Rate for Payer: Aetna of VT Commercial |
$390.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$333.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.96
|
| Rate for Payer: Cash Price |
$205.64
|
| Rate for Payer: Cash Price |
$205.64
|
| Rate for Payer: Cigna Commercial |
$329.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$329.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$329.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.07
|
| Rate for Payer: Multiplan Commercial |
$382.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.07
|
| Rate for Payer: United Healthcare Commercial |
$390.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.07
|
| Rate for Payer: United Healthcare VA CCN |
$185.07
|
|
|
XR PELVIS 1/2 VIEWS
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 72170 26
|
| Hospital Charge Code |
9727217001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna of VT Commercial |
$123.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$120.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.50
|
| Rate for Payer: United Healthcare Commercial |
$123.50
|
|
|
XR PELVIS COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$470.98
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
3207219001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$447.43 |
| Rate for Payer: Aetna of VT Commercial |
$447.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.43
|
| Rate for Payer: Cash Price |
$235.49
|
| Rate for Payer: Cash Price |
$235.49
|
| Rate for Payer: Cigna Commercial |
$376.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.94
|
| Rate for Payer: Multiplan Commercial |
$438.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.94
|
| Rate for Payer: United Healthcare Commercial |
$447.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.94
|
| Rate for Payer: United Healthcare VA CCN |
$211.94
|
|
|
XR PELVIS COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$470.98
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
3207219001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$447.43 |
| Rate for Payer: Aetna of VT Commercial |
$447.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$400.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$395.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.78
|
| Rate for Payer: Cash Price |
$235.49
|
| Rate for Payer: Cigna Commercial |
$376.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.78
|
| Rate for Payer: Multiplan Commercial |
$438.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$400.33
|
| Rate for Payer: United Healthcare Commercial |
$447.43
|
|
|
XR PELVIS COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
9727219001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.00
|
| Rate for Payer: United Healthcare VA CCN |
$54.00
|
|
|
XR PELVIS COMPL MIN 3 VIEWS
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
9727219001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna of VT Commercial |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.80
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$17.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare VA CCN |
$11.47
|
|
|
XR PELVIS COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
9727219001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$88.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of VT Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$96.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$111.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$114.00
|
|
|
XR RIBS BILAT 3 VIEWS
|
Facility
|
OP
|
$750.17
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
3207111001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$712.66 |
| Rate for Payer: Aetna of VT Commercial |
$712.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$332.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$451.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$637.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$607.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$337.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$596.39
|
| Rate for Payer: Cash Price |
$375.08
|
| Rate for Payer: Cash Price |
$375.08
|
| Rate for Payer: Cigna Commercial |
$600.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$337.58
|
| Rate for Payer: Multiplan Commercial |
$697.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$637.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$337.58
|
| Rate for Payer: United Healthcare Commercial |
$712.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$337.58
|
| Rate for Payer: United Healthcare VA CCN |
$337.58
|
|
|
XR RIBS BILAT 3 VIEWS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 71110 26
|
| Hospital Charge Code |
9727111001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna of VT Commercial |
$110.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.80
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.60
|
| Rate for Payer: United Healthcare Commercial |
$110.20
|
|
|
XR RIBS BILAT 3 VIEWS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 71110 26
|
| Hospital Charge Code |
9727111001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna of VT Commercial |
$110.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.22
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.20
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.20
|
| Rate for Payer: United Healthcare Commercial |
$110.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.20
|
| Rate for Payer: United Healthcare VA CCN |
$52.20
|
|
|
XR RIBS BILAT 3 VIEWS
|
Facility
|
IP
|
$750.17
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
3207111001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$712.66 |
| Rate for Payer: Aetna of VT Commercial |
$712.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$555.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$555.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$637.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$630.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$600.14
|
| Rate for Payer: Cash Price |
$375.08
|
| Rate for Payer: Cigna Commercial |
$600.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$600.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$600.14
|
| Rate for Payer: Multiplan Commercial |
$697.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$637.64
|
| Rate for Payer: United Healthcare Commercial |
$712.66
|
|
|
XR RIBS BILAT 3 VIEWS
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 71110 26
|
| Hospital Charge Code |
9727111001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna of VT Commercial |
$109.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.93
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$19.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$107.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.08
|
| Rate for Payer: United Healthcare Commercial |
$20.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: United Healthcare VA CCN |
$13.08
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 71101 26
|
| Hospital Charge Code |
9727110101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$128.41 |
| Rate for Payer: Aetna of VT Commercial |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$18.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare VA CCN |
$12.11
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
OP
|
$640.05
|
|
|
Service Code
|
CPT 71101 RT
|
| Hospital Charge Code |
32071101RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$608.05 |
| Rate for Payer: Aetna of VT Commercial |
$608.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$283.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$385.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$518.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$288.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$508.84
|
| Rate for Payer: Cash Price |
$320.02
|
| Rate for Payer: Cash Price |
$320.02
|
| Rate for Payer: Cigna Commercial |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$288.02
|
| Rate for Payer: Multiplan Commercial |
$595.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$288.02
|
| Rate for Payer: United Healthcare Commercial |
$608.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.02
|
| Rate for Payer: United Healthcare VA CCN |
$288.02
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$640.05
|
|
|
Service Code
|
CPT 71101 LT
|
| Hospital Charge Code |
32071101LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$473.70 |
| Max. Negotiated Rate |
$608.05 |
| Rate for Payer: Aetna of VT Commercial |
$608.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$473.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$473.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$544.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$537.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.04
|
| Rate for Payer: Cash Price |
$320.02
|
| Rate for Payer: Cigna Commercial |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.04
|
| Rate for Payer: Multiplan Commercial |
$595.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$544.04
|
| Rate for Payer: United Healthcare Commercial |
$608.05
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
OP
|
$596.62
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
3207110101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$566.79 |
| Rate for Payer: Aetna of VT Commercial |
$566.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$359.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$507.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$474.31
|
| Rate for Payer: Cash Price |
$298.31
|
| Rate for Payer: Cash Price |
$298.31
|
| Rate for Payer: Cigna Commercial |
$477.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$477.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$477.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$268.48
|
| Rate for Payer: Multiplan Commercial |
$554.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$507.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$268.48
|
| Rate for Payer: United Healthcare Commercial |
$566.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$268.48
|
| Rate for Payer: United Healthcare VA CCN |
$268.48
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$596.62
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
3207110101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.56 |
| Max. Negotiated Rate |
$566.79 |
| Rate for Payer: Aetna of VT Commercial |
$566.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$441.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$441.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$507.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$501.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$477.30
|
| Rate for Payer: Cash Price |
$298.31
|
| Rate for Payer: Cigna Commercial |
$477.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$477.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$477.30
|
| Rate for Payer: Multiplan Commercial |
$554.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$507.13
|
| Rate for Payer: United Healthcare Commercial |
$566.79
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 71101 26
|
| Hospital Charge Code |
9727110101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.80
|
| Rate for Payer: United Healthcare VA CCN |
$37.80
|
|
|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 71101 26
|
| Hospital Charge Code |
9727110101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna of VT Commercial |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$78.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$79.80
|
|
