|
XR SINSUSES PARANSL MIN 3 VIEW
|
Facility
|
IP
|
$527.34
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
3207022001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$390.28 |
| 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 |
$390.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$390.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$448.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$442.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$421.87
|
| 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: Multiplan Commercial |
$490.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$448.24
|
| Rate for Payer: United Healthcare Commercial |
$500.97
|
|
|
XR SINUSES PARANASAL <3 VIEWS
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 70210 26
|
| Hospital Charge Code |
9727021001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna of VT Commercial |
$73.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.22
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.65
|
| Rate for Payer: United Healthcare Commercial |
$73.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.65
|
| Rate for Payer: United Healthcare VA CCN |
$34.65
|
|
|
XR SINUSES PARANASAL <3 VIEWS
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 70210 26
|
| Hospital Charge Code |
9727021001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna of VT Commercial |
$73.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.60
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.45
|
| Rate for Payer: United Healthcare Commercial |
$73.15
|
|
|
XR SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 70210 26
|
| Hospital Charge Code |
9727021001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$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 |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$12.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| 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 SINUSES PARANASAL <3 VIEWS
|
Facility
|
OP
|
$277.11
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
3207021001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna of VT Commercial |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$220.30
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cigna Commercial |
$221.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$124.70
|
| Rate for Payer: Multiplan Commercial |
$257.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$124.70
|
| Rate for Payer: United Healthcare Commercial |
$263.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.70
|
| Rate for Payer: United Healthcare VA CCN |
$124.70
|
|
|
XR SINUSES PARANASAL <3 VIEWS
|
Facility
|
IP
|
$277.11
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
3207021001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.09 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna of VT Commercial |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.69
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cigna Commercial |
$221.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$221.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$221.69
|
| Rate for Payer: Multiplan Commercial |
$257.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.54
|
| Rate for Payer: United Healthcare Commercial |
$263.25
|
|
|
XR SKULL 4< VIEWS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 70250 26
|
| Hospital Charge Code |
9727025001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna of VT Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.40
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.40
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
|
|
XR SKULL 4< VIEWS
|
Facility
|
IP
|
$518.09
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
3207025001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.44 |
| Max. Negotiated Rate |
$492.19 |
| Rate for Payer: Aetna of VT Commercial |
$492.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$383.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$383.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$435.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.47
|
| Rate for Payer: Cash Price |
$259.04
|
| Rate for Payer: Cigna Commercial |
$414.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.47
|
| Rate for Payer: Multiplan Commercial |
$481.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.38
|
| Rate for Payer: United Healthcare Commercial |
$492.19
|
|
|
XR SKULL 4< VIEWS
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 70250 26
|
| Hospital Charge Code |
9727025001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna of VT Commercial |
$92.12
|
| 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 |
$8.49
|
| 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 |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.39
|
| 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 |
$16.39
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$12.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| 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 SKULL 4< VIEWS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 70250 26
|
| Hospital Charge Code |
9727025001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna of VT Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.91
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$91.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.10
|
| Rate for Payer: United Healthcare Commercial |
$93.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.10
|
| Rate for Payer: United Healthcare VA CCN |
$44.10
|
|
|
XR SKULL 4< VIEWS
|
Facility
|
OP
|
$518.09
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
3207025001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$492.19 |
| Rate for Payer: Aetna of VT Commercial |
$492.19
|
| 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 |
$229.46
|
| 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 |
$311.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$440.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$233.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.88
|
| Rate for Payer: Cash Price |
$259.04
|
| Rate for Payer: Cash Price |
$259.04
|
| Rate for Payer: Cigna Commercial |
$414.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$414.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$414.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$233.14
|
| Rate for Payer: Multiplan Commercial |
$481.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$233.14
|
| Rate for Payer: United Healthcare Commercial |
$492.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.14
|
| Rate for Payer: United Healthcare VA CCN |
$233.14
|
|
|
XR SKULL COMPL MIN 4 VIEWS
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 70260 26
|
| Hospital Charge Code |
9727026001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna of VT Commercial |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$81.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.33
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.75
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.75
|
| Rate for Payer: United Healthcare VA CCN |
$60.75
|
|
|
XR SKULL COMPL MIN 4 VIEWS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 70260 26
|
| Hospital Charge Code |
9727026001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna of VT Commercial |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
|
|
XR SKULL COMPL MIN 4 VIEWS
|
Facility
|
OP
|
$814.79
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
3207026001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.62 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna of VT Commercial |
$774.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$360.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$490.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$692.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$366.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$647.76
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$651.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$651.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$651.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$366.66
|
| Rate for Payer: Multiplan Commercial |
$757.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$692.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$366.66
|
| Rate for Payer: United Healthcare Commercial |
$774.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.66
|
| Rate for Payer: United Healthcare VA CCN |
$366.66
|
|
|
XR SKULL COMPL MIN 4 VIEWS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 70260 26
|
| Hospital Charge Code |
9727026001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$135.62 |
| Rate for Payer: Aetna of VT Commercial |
$126.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$135.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$135.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.35
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$19.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare VA CCN |
$12.76
|
|
|
XR SKULL COMPL MIN 4 VIEWS
|
Facility
|
IP
|
$814.79
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
3207026001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$603.03 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna of VT Commercial |
$774.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$692.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$684.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$651.83
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$651.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$651.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$651.83
|
| Rate for Payer: Multiplan Commercial |
$757.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$692.57
|
| Rate for Payer: United Healthcare Commercial |
$774.05
|
|
|
XR SPINE 1 VIEW SPECIFY LEVEL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 72020 26
|
| Hospital Charge Code |
9727202001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna of VT Commercial |
$58.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.29
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.90
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.90
|
| Rate for Payer: United Healthcare VA CCN |
$27.90
|
|
|
XR SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 72020 26
|
| Hospital Charge Code |
9727202001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$72.04 |
| Rate for Payer: Aetna of VT Commercial |
$58.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.10
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare VA CCN |
$7.27
|
|
|
XR SPINE 1 VIEW SPECIFY LEVEL
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 72020 26
|
| Hospital Charge Code |
9727202001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$45.89 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna of VT Commercial |
$58.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.60
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$57.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.70
|
| Rate for Payer: United Healthcare Commercial |
$58.90
|
|
|
XR SPINE 1 VIEW SPECIFY LEVEL
|
Facility
|
IP
|
$367.07
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
3207202001
|
|
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 SPINE 1 VIEW SPECIFY LEVEL
|
Facility
|
OP
|
$367.07
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
3207202001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.04 |
| 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 |
$72.04
|
| 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 |
$72.04
|
| 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 SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 72040 26
|
| Hospital Charge Code |
9727204001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$125.51 |
| Rate for Payer: Aetna of VT Commercial |
$91.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| 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 |
$125.51
|
| 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 |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.06
|
| 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 |
$16.06
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$15.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.17
|
| Rate for Payer: United Healthcare VA CCN |
$10.17
|
|
|
XR SPINE CERVICAL 2 OR 3 VIEWS
|
Facility
|
OP
|
$413.60
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
3207204001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$392.92 |
| Rate for Payer: Aetna of VT Commercial |
$392.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$335.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$186.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.81
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cigna Commercial |
$330.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$330.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$330.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$186.12
|
| Rate for Payer: Multiplan Commercial |
$384.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.12
|
| Rate for Payer: United Healthcare Commercial |
$392.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.12
|
| Rate for Payer: United Healthcare VA CCN |
$186.12
|
|
|
XR SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$413.60
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
3207204001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$388.78 |
| Rate for Payer: Aetna of VT Commercial |
$388.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.44
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cigna Commercial |
$57.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.96
|
| Rate for Payer: Multiplan Commercial |
$384.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.97
|
| Rate for Payer: United Healthcare Commercial |
$58.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.97
|
| Rate for Payer: United Healthcare VA CCN |
$37.97
|
|
|
XR SPINE CERVICAL 2 OR 3 VIEWS
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 72040 26
|
| Hospital Charge Code |
9727204001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna of VT Commercial |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.11
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.65
|
| Rate for Payer: Multiplan Commercial |
$90.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.65
|
| Rate for Payer: United Healthcare VA CCN |
$43.65
|
|
