|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
OP
|
$596.62
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
3207220201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.06 |
| 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 |
$124.06
|
| 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 |
$124.06
|
| 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 SACROILIAC JNTS 3/> VIEWS
|
Facility
|
OP
|
$537.88
|
|
|
Service Code
|
CPT 72202 LT
|
| Hospital Charge Code |
32072202LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.06 |
| Max. Negotiated Rate |
$510.99 |
| Rate for Payer: Aetna of VT Commercial |
$510.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$323.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$242.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$427.61
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cigna Commercial |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$242.05
|
| Rate for Payer: Multiplan Commercial |
$500.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$242.05
|
| Rate for Payer: United Healthcare Commercial |
$510.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.05
|
| Rate for Payer: United Healthcare VA CCN |
$242.05
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
IP
|
$537.88
|
|
|
Service Code
|
CPT 72202 RT
|
| Hospital Charge Code |
32072202RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$398.08 |
| Max. Negotiated Rate |
$510.99 |
| Rate for Payer: Aetna of VT Commercial |
$510.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.30
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cigna Commercial |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.30
|
| Rate for Payer: Multiplan Commercial |
$500.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.20
|
| Rate for Payer: United Healthcare Commercial |
$510.99
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
IP
|
$537.88
|
|
|
Service Code
|
CPT 72202 LT
|
| Hospital Charge Code |
32072202LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$398.08 |
| Max. Negotiated Rate |
$510.99 |
| Rate for Payer: Aetna of VT Commercial |
$510.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.30
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cigna Commercial |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.30
|
| Rate for Payer: Multiplan Commercial |
$500.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.20
|
| Rate for Payer: United Healthcare Commercial |
$510.99
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 72202 26
|
| Hospital Charge Code |
9727220201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$124.06 |
| Rate for Payer: Aetna of VT Commercial |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.93
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$15.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare VA CCN |
$10.18
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 72202 26
|
| Hospital Charge Code |
9727220201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare VA CCN |
$46.80
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
IP
|
$596.62
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
3207220201
|
|
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 SACROILIAC JNTS 3/> VIEWS
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 72202 26
|
| Hospital Charge Code |
9727220201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
XR SACROILIAC JNTS 3/> VIEWS
|
Facility
|
OP
|
$537.88
|
|
|
Service Code
|
CPT 72202 RT
|
| Hospital Charge Code |
32072202RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.06 |
| Max. Negotiated Rate |
$510.99 |
| Rate for Payer: Aetna of VT Commercial |
$510.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$323.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$242.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$427.61
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cash Price |
$268.94
|
| Rate for Payer: Cigna Commercial |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$242.05
|
| Rate for Payer: Multiplan Commercial |
$500.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$242.05
|
| Rate for Payer: United Healthcare Commercial |
$510.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.05
|
| Rate for Payer: United Healthcare VA CCN |
$242.05
|
|
|
XR SACRUM & COCCYX MIN 2 VIEWS
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 72220 26
|
| Hospital Charge Code |
9727222001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of VT Commercial |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.88
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.80
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.80
|
| Rate for Payer: United Healthcare VA CCN |
$28.80
|
|
|
XR SACRUM & COCCYX MIN 2 VIEWS
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 72220 26
|
| Hospital Charge Code |
9727222001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna of VT Commercial |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.40
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
|
|
XR SACRUM & COCCYX MIN 2 VIEWS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 72220 26
|
| Hospital Charge Code |
9727222001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna of VT Commercial |
$60.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.07
|
| 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 |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$12.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$59.52
|
| 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 SACRUM & COCCYX MIN 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
3207222001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.36
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.75
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare VA CCN |
$197.75
|
|
|
XR SACRUM & COCCYX MIN 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
3207222001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 73010 26
|
| Hospital Charge Code |
9727301001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$78.39 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna of VT Commercial |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$158.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$158.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.72
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$141.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.65
|
| Rate for Payer: Multiplan Commercial |
$164.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.65
|
| Rate for Payer: United Healthcare Commercial |
$168.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.65
|
| Rate for Payer: United Healthcare VA CCN |
$79.65
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
OP
|
$616.55
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
32073010LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$585.72 |
| Rate for Payer: Aetna of VT Commercial |
$585.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$371.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$499.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$277.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.16
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cigna Commercial |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$277.45
|
| Rate for Payer: Multiplan Commercial |
$573.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$277.45
|
| Rate for Payer: United Healthcare Commercial |
$585.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$277.45
|
| Rate for Payer: United Healthcare VA CCN |
$277.45
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 73010 26
|
| Hospital Charge Code |
9727301001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna of VT Commercial |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.60
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$141.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$141.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$141.60
|
| Rate for Payer: Multiplan Commercial |
$164.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.45
|
| Rate for Payer: United Healthcare Commercial |
$168.15
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
OP
|
$390.85
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
3207301001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$371.31 |
| Rate for Payer: Aetna of VT Commercial |
$371.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$173.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$235.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$332.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$316.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.73
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Cigna Commercial |
$312.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.88
|
| Rate for Payer: Multiplan Commercial |
$363.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$332.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.88
|
| Rate for Payer: United Healthcare Commercial |
$371.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.88
|
| Rate for Payer: United Healthcare VA CCN |
$175.88
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
IP
|
$616.55
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
32073010LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$456.31 |
| Max. Negotiated Rate |
$585.72 |
| Rate for Payer: Aetna of VT Commercial |
$585.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$456.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$456.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$517.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$493.24
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cigna Commercial |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.24
|
| Rate for Payer: Multiplan Commercial |
$573.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.07
|
| Rate for Payer: United Healthcare Commercial |
$585.72
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
OP
|
$616.55
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
32073010RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$585.72 |
| Rate for Payer: Aetna of VT Commercial |
$585.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$371.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$499.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$277.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.16
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cigna Commercial |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$277.45
|
| Rate for Payer: Multiplan Commercial |
$573.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$277.45
|
| Rate for Payer: United Healthcare Commercial |
$585.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$277.45
|
| Rate for Payer: United Healthcare VA CCN |
$277.45
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
IP
|
$616.55
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
32073010RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$456.31 |
| Max. Negotiated Rate |
$585.72 |
| Rate for Payer: Aetna of VT Commercial |
$585.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$456.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$456.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$517.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$493.24
|
| Rate for Payer: Cash Price |
$308.28
|
| Rate for Payer: Cigna Commercial |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$493.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$493.24
|
| Rate for Payer: Multiplan Commercial |
$573.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$524.07
|
| Rate for Payer: United Healthcare Commercial |
$585.72
|
|
|
XR SCAPULA COMPLETE
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 73010 26
|
| Hospital Charge Code |
9727301001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$166.38 |
| Rate for Payer: Aetna of VT Commercial |
$166.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.22
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$12.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$164.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$8.24
|
|
|
XR SCAPULA COMPLETE
|
Facility
|
IP
|
$390.85
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
3207301001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.27 |
| Max. Negotiated Rate |
$371.31 |
| Rate for Payer: Aetna of VT Commercial |
$371.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$289.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$289.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$332.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$328.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.68
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Cigna Commercial |
$312.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.68
|
| Rate for Payer: Multiplan Commercial |
$363.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$332.22
|
| Rate for Payer: United Healthcare Commercial |
$371.31
|
|
|
XR SHOULDER 1 VIEW
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 73020 26
|
| Hospital Charge Code |
9727302001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.40
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
|
|
XR SHOULDER 1 VIEW
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 73020 26
|
| Hospital Charge Code |
9727302001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.03
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare VA CCN |
$32.85
|
|
