|
XR SHOULDER 1 VIEW
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
3207302001
|
|
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 SHOULDER 1 VIEW
|
Facility
|
IP
|
$367.07
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
32073020RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.67 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.66
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
|
|
XR SHOULDER 1 VIEW
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
3207302001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.92 |
| 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 |
$61.92
|
| 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 |
$61.92
|
| 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 SHOULDER 1 VIEW
|
Facility
|
IP
|
$367.07
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
32073020LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.67 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$271.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.66
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
|
|
XR SHOULDER 1 VIEW
|
Facility
|
OP
|
$367.07
|
|
|
Service Code
|
CPT 73020 LT
|
| Hospital Charge Code |
32073020LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.82
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.18
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare VA CCN |
$165.18
|
|
|
XR SHOULDER 1 VIEW
|
Facility
|
OP
|
$367.07
|
|
|
Service Code
|
CPT 73020 RT
|
| Hospital Charge Code |
32073020RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$348.72 |
| Rate for Payer: Aetna of VT Commercial |
$348.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$162.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$220.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$312.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$291.82
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cigna Commercial |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$293.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$293.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.18
|
| Rate for Payer: Multiplan Commercial |
$341.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$312.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare Commercial |
$348.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.18
|
| Rate for Payer: United Healthcare VA CCN |
$165.18
|
|
|
XR SHOULDER 1 VIEW
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 73020 26
|
| Hospital Charge Code |
9727302001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$68.62 |
| Rate for Payer: Aetna of VT Commercial |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.01
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$10.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
32073030LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna of VT Commercial |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.91
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna Commercial |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.38
|
| Rate for Payer: Multiplan Commercial |
$432.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.38
|
| Rate for Payer: United Healthcare Commercial |
$442.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.38
|
| Rate for Payer: United Healthcare VA CCN |
$209.38
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
3207303001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$381.10 |
| Max. Negotiated Rate |
$489.18 |
| Rate for Payer: Aetna of VT Commercial |
$489.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$381.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$381.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$432.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.94
|
| Rate for Payer: Cash Price |
$257.46
|
| Rate for Payer: Cigna Commercial |
$411.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$411.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$411.94
|
| Rate for Payer: Multiplan Commercial |
$478.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$437.69
|
| Rate for Payer: United Healthcare Commercial |
$489.18
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
32073030RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna of VT Commercial |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$369.91
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna Commercial |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.38
|
| Rate for Payer: Multiplan Commercial |
$432.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.38
|
| Rate for Payer: United Healthcare Commercial |
$442.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.38
|
| Rate for Payer: United Healthcare VA CCN |
$209.38
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 73030 26
|
| Hospital Charge Code |
9727303001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
CPT 73030 RT
|
| Hospital Charge Code |
32073030RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.37 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna of VT Commercial |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.24
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna Commercial |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.24
|
| Rate for Payer: Multiplan Commercial |
$432.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.50
|
| Rate for Payer: United Healthcare Commercial |
$442.04
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 73030 26
|
| Hospital Charge Code |
9727303001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.42
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare VA CCN |
$51.75
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
OP
|
$514.93
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
3207303001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$489.18 |
| Rate for Payer: Aetna of VT Commercial |
$489.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$309.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$437.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$231.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$409.37
|
| Rate for Payer: Cash Price |
$257.46
|
| Rate for Payer: Cash Price |
$257.46
|
| Rate for Payer: Cigna Commercial |
$411.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$411.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$411.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.72
|
| Rate for Payer: Multiplan Commercial |
$478.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$437.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.72
|
| Rate for Payer: United Healthcare Commercial |
$489.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.72
|
| Rate for Payer: United Healthcare VA CCN |
$231.72
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 73030 26
|
| Hospital Charge Code |
9727303001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$112.49 |
| Rate for Payer: Aetna of VT Commercial |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.76
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$13.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare VA CCN |
$8.56
|
|
|
XR SHOULDER COMPL MIN 2 VIEW
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
CPT 73030 LT
|
| Hospital Charge Code |
32073030LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.37 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna of VT Commercial |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$395.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.24
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna Commercial |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.24
|
| Rate for Payer: Multiplan Commercial |
$432.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$395.50
|
| Rate for Payer: United Healthcare Commercial |
$442.04
|
|
|
XR SHOULDERS W/WO WGHTD DISTRC
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 73050 26
|
| Hospital Charge Code |
9727305001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
|
|
XR SHOULDERS W/WO WGHTD DISTRC
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 73050 26
|
| Hospital Charge Code |
9727305001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.50
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare VA CCN |
$45.00
|
|
|
XR SHOULDERS W/WO WGHTD DISTRC
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 73050 26
|
| Hospital Charge Code |
9727305001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Aetna of VT Commercial |
$94.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.43
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$13.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare VA CCN |
$8.56
|
|
|
XR SHOULDERS W/WO WGHTD DISTRC
|
Facility
|
IP
|
$752.75
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$557.11 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna of VT Commercial |
$715.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$557.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$557.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$639.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$632.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$602.20
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cigna Commercial |
$602.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$602.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$602.20
|
| Rate for Payer: Multiplan Commercial |
$700.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$639.84
|
| Rate for Payer: United Healthcare Commercial |
$715.11
|
|
|
XR SHOULDERS W/WO WGHTD DISTRC
|
Facility
|
OP
|
$752.75
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna of VT Commercial |
$715.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$333.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$453.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$639.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$609.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$338.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$598.44
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cash Price |
$376.38
|
| Rate for Payer: Cigna Commercial |
$602.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$602.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$602.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$338.74
|
| Rate for Payer: Multiplan Commercial |
$700.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$639.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$338.74
|
| Rate for Payer: United Healthcare Commercial |
$715.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$338.74
|
| Rate for Payer: United Healthcare VA CCN |
$338.74
|
|
|
XR SINSUSES PARANSL MIN 3 VIEW
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 70220 26
|
| Hospital Charge Code |
9727022001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna of VT Commercial |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.40
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.55
|
| Rate for Payer: United Healthcare Commercial |
$97.85
|
|
|
XR SINSUSES PARANSL MIN 3 VIEW
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 70220 26
|
| Hospital Charge Code |
9727022001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna of VT Commercial |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.89
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.35
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare Commercial |
$97.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare VA CCN |
$46.35
|
|
|
XR SINSUSES PARANSL MIN 3 VIEW
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 70220 26
|
| Hospital Charge Code |
9727022001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna of VT Commercial |
$96.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.31
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$14.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$15.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.85
|
| Rate for Payer: United Healthcare VA CCN |
$9.85
|
|
|
XR SINSUSES PARANSL MIN 3 VIEW
|
Facility
|
OP
|
$527.34
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
3207022001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$500.97 |
| Rate for Payer: Aetna of VT Commercial |
$500.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$448.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$427.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$237.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.24
|
| Rate for Payer: Cash Price |
$263.67
|
| Rate for Payer: Cash Price |
$263.67
|
| Rate for Payer: Cigna Commercial |
$421.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$421.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$421.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$490.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$237.30
|
| Rate for Payer: United Healthcare Commercial |
$500.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.30
|
| Rate for Payer: United Healthcare VA CCN |
$237.30
|
|
