|
XR RIBS/CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$640.05
|
|
|
Service Code
|
CPT 71101 RT
|
| Hospital Charge Code |
32071101RT
|
|
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
|
$640.05
|
|
|
Service Code
|
CPT 71101 LT
|
| Hospital Charge Code |
32071101LT
|
|
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 4 VIEWS
|
Facility
|
OP
|
$773.43
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
3207111101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.65 |
| Max. Negotiated Rate |
$734.76 |
| Rate for Payer: Aetna of VT Commercial |
$734.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$342.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$465.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$626.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$614.88
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cigna Commercial |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.04
|
| Rate for Payer: Multiplan Commercial |
$719.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$348.04
|
| Rate for Payer: United Healthcare Commercial |
$734.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.04
|
| Rate for Payer: United Healthcare VA CCN |
$348.04
|
|
|
XR RIBS/CHEST MIN 4 VIEWS
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 71111 26
|
| Hospital Charge Code |
9727111101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$60.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.12
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.20
|
| Rate for Payer: United Healthcare VA CCN |
$61.20
|
|
|
XR RIBS/CHEST MIN 4 VIEWS
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 71111 26
|
| Hospital Charge Code |
9727111101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$161.65 |
| Rate for Payer: Aetna of VT Commercial |
$127.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.87
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$22.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.54
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.54
|
| Rate for Payer: United Healthcare Commercial |
$22.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.54
|
| Rate for Payer: United Healthcare VA CCN |
$14.54
|
|
|
XR RIBS/CHEST MIN 4 VIEWS
|
Facility
|
IP
|
$773.43
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
3207111101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$572.42 |
| Max. Negotiated Rate |
$734.76 |
| Rate for Payer: Aetna of VT Commercial |
$734.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$657.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$649.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$618.74
|
| Rate for Payer: Cash Price |
$386.71
|
| Rate for Payer: Cigna Commercial |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$618.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$618.74
|
| Rate for Payer: Multiplan Commercial |
$719.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$657.42
|
| Rate for Payer: United Healthcare Commercial |
$734.76
|
|
|
XR RIBS/CHEST MIN 4 VIEWS
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 71111 26
|
| Hospital Charge Code |
9727111101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna of VT Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.80
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$126.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.60
|
| Rate for Payer: United Healthcare Commercial |
$129.20
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$518.03
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
32071100LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$492.13 |
| Rate for Payer: Aetna of VT Commercial |
$492.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$311.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.83
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cigna Commercial |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$233.11
|
| Rate for Payer: Multiplan Commercial |
$481.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.11
|
| Rate for Payer: United Healthcare Commercial |
$492.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.11
|
| Rate for Payer: United Healthcare VA CCN |
$233.11
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 71100 26
|
| Hospital Charge Code |
9727110001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of VT Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 71100 26
|
| Hospital Charge Code |
9727110001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of VT Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.24
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.40
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.40
|
| Rate for Payer: United Healthcare VA CCN |
$32.40
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 71100 26
|
| Hospital Charge Code |
9727110001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$113.94 |
| Rate for Payer: Aetna of VT Commercial |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| 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 |
$113.94
|
| 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 |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.57
|
| 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 |
$16.57
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$14.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| 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 RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$518.03
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
32071100RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.39 |
| Max. Negotiated Rate |
$492.13 |
| Rate for Payer: Aetna of VT Commercial |
$492.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$383.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$383.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.42
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cigna Commercial |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.42
|
| Rate for Payer: Multiplan Commercial |
$481.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.33
|
| Rate for Payer: United Healthcare Commercial |
$492.13
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
3207110001
|
|
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 RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
3207110001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| 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 |
$113.94
|
| 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 |
$113.94
|
| 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 RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$518.03
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
32071100RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$492.13 |
| Rate for Payer: Aetna of VT Commercial |
$492.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$311.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.83
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cigna Commercial |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$233.11
|
| Rate for Payer: Multiplan Commercial |
$481.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.11
|
| Rate for Payer: United Healthcare Commercial |
$492.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.11
|
| Rate for Payer: United Healthcare VA CCN |
$233.11
|
|
|
XR RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$518.03
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
32071100LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.39 |
| Max. Negotiated Rate |
$492.13 |
| Rate for Payer: Aetna of VT Commercial |
$492.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$383.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$383.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.42
|
| Rate for Payer: Cash Price |
$259.02
|
| Rate for Payer: Cigna Commercial |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.42
|
| Rate for Payer: Multiplan Commercial |
$481.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.33
|
| Rate for Payer: United Healthcare Commercial |
$492.13
|
|
|
XR SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 72200 26
|
| Hospital Charge Code |
9727220001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$109.63 |
| Rate for Payer: Aetna of VT Commercial |
$81.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.63
|
| 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 |
$109.63
|
| 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 |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| 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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 72200 LT
|
| Hospital Charge Code |
32072200LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.63 |
| 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 |
$109.63
|
| 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 |
$109.63
|
| 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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 72200 26
|
| Hospital Charge Code |
9727220001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$64.39 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.60
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
|
|
XR SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 72200 RT
|
| Hospital Charge Code |
32072200RT
|
|
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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
3207220001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.63 |
| 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 |
$109.63
|
| 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 |
$109.63
|
| 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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 72200 RT
|
| Hospital Charge Code |
32072200RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.63 |
| 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 |
$109.63
|
| 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 |
$109.63
|
| 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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 72200 26
|
| Hospital Charge Code |
9727220001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna of VT Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.17
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$80.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: United Healthcare VA CCN |
$39.15
|
|
|
XR SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 72200 LT
|
| Hospital Charge Code |
32072200LT
|
|
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 SACROILIAC JNTS <3 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
3207220001
|
|
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
|
|
