|
XR THORACIC MIN 4 VIEWS
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
CPT 72074 26
|
| Hospital Charge Code |
9727207401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$142.83 |
| Rate for Payer: Aetna of VT Commercial |
$125.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.78
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$16.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$123.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.14
|
| Rate for Payer: United Healthcare Commercial |
$17.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.14
|
| Rate for Payer: United Healthcare VA CCN |
$11.14
|
|
|
XR THORACIC MIN 4 VIEWS
|
Facility
|
IP
|
$646.77
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
3207207401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.67 |
| Max. Negotiated Rate |
$614.43 |
| Rate for Payer: Aetna of VT Commercial |
$614.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$478.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$478.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.42
|
| Rate for Payer: Cash Price |
$323.38
|
| Rate for Payer: Cigna Commercial |
$517.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.42
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.75
|
| Rate for Payer: United Healthcare Commercial |
$614.43
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Facility
|
IP
|
$493.19
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
3207207001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.01 |
| Max. Negotiated Rate |
$468.53 |
| Rate for Payer: Aetna of VT Commercial |
$468.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$394.55
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$394.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.55
|
| Rate for Payer: Multiplan Commercial |
$458.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.21
|
| Rate for Payer: United Healthcare Commercial |
$468.53
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 72070 26
|
| Hospital Charge Code |
9727207001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.20
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 72070 26
|
| Hospital Charge Code |
9727207001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$100.97 |
| Rate for Payer: Aetna of VT Commercial |
$69.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.56
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$13.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$14.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.21
|
| Rate for Payer: United Healthcare VA CCN |
$9.21
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 72070 26
|
| Hospital Charge Code |
9727207001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna of VT Commercial |
$70.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.83
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.30
|
| Rate for Payer: Multiplan Commercial |
$68.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.30
|
| Rate for Payer: United Healthcare VA CCN |
$33.30
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Professional
|
Both
|
$493.19
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
3207207001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.53 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna of VT Commercial |
$463.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.41
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$47.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.53
|
| Rate for Payer: Multiplan Commercial |
$458.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.54
|
| Rate for Payer: United Healthcare Commercial |
$48.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.54
|
| Rate for Payer: United Healthcare VA CCN |
$31.54
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Facility
|
OP
|
$493.19
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
3207207001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.97 |
| Max. Negotiated Rate |
$468.53 |
| Rate for Payer: Aetna of VT Commercial |
$468.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$296.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$221.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$394.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$394.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$394.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$221.94
|
| Rate for Payer: Multiplan Commercial |
$458.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$221.94
|
| Rate for Payer: United Healthcare Commercial |
$468.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.94
|
| Rate for Payer: United Healthcare VA CCN |
$221.94
|
|
|
XR TIBIA & FIBULA 2 VIEWS
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 73590 26
|
| Hospital Charge Code |
9727359001
|
|
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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
CPT 73590 LT
|
| Hospital Charge Code |
32073590LT
|
|
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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
CPT 73590 RT
|
| Hospital Charge Code |
32073590RT
|
|
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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
OP
|
$514.93
|
|
|
Service Code
|
CPT 73590 RT
|
| Hospital Charge Code |
32073590RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| 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 |
$103.83
|
| 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 |
$103.83
|
| 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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 73590 26
|
| Hospital Charge Code |
9727359001
|
|
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 TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 73590 26
|
| Hospital Charge Code |
9727359001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$58.28
|
| 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 |
$7.49
|
| 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 |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.93
|
| 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 |
$12.93
|
| 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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
OP
|
$426.01
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
3207359001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$404.71 |
| Rate for Payer: Aetna of VT Commercial |
$404.71
|
| 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 |
$188.68
|
| 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 |
$256.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$362.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.68
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$340.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.70
|
| Rate for Payer: Multiplan Commercial |
$396.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$362.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.70
|
| Rate for Payer: United Healthcare Commercial |
$404.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.70
|
| Rate for Payer: United Healthcare VA CCN |
$191.70
|
|
|
XR TIBIA & FIBULA 2 VIEWS
|
Facility
|
OP
|
$514.93
|
|
|
Service Code
|
CPT 73590 LT
|
| Hospital Charge Code |
32073590LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| 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 |
$103.83
|
| 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 |
$103.83
|
| 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 TIBIA & FIBULA 2 VIEWS
|
Facility
|
IP
|
$426.01
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
3207359001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.29 |
| Max. Negotiated Rate |
$404.71 |
| Rate for Payer: Aetna of VT Commercial |
$404.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$315.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$315.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$362.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.81
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$340.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.81
|
| Rate for Payer: Multiplan Commercial |
$396.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$362.11
|
| Rate for Payer: United Healthcare Commercial |
$404.71
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 73660 RT
|
| Hospital Charge Code |
32073660RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.42 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$451.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$451.20
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$479.40
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
|
|
XR TOE MIN 2 VIEWS
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
CPT 73660 26
|
| Hospital Charge Code |
9727366001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna of VT Commercial |
$61.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.08
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$9.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.98
|
| Rate for Payer: United Healthcare Commercial |
$9.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: United Healthcare VA CCN |
$5.98
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 73660 LT
|
| Hospital Charge Code |
32073660LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.52 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$249.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$339.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$448.38
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$451.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.80
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$479.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.80
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.80
|
| Rate for Payer: United Healthcare VA CCN |
$253.80
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 73660 LT
|
| Hospital Charge Code |
32073660LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.42 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna of VT Commercial |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$417.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$479.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$451.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$451.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$451.20
|
| Rate for Payer: Multiplan Commercial |
$524.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$479.40
|
| Rate for Payer: United Healthcare Commercial |
$535.80
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
IP
|
$459.10
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$339.78 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$339.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$367.28
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
OP
|
$459.10
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.52 |
| Max. Negotiated Rate |
$436.14 |
| Rate for Payer: Aetna of VT Commercial |
$436.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$203.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$276.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$390.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$371.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$206.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.98
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cash Price |
$229.55
|
| Rate for Payer: Cigna Commercial |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$206.59
|
| Rate for Payer: Multiplan Commercial |
$426.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$390.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare Commercial |
$436.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.59
|
| Rate for Payer: United Healthcare VA CCN |
$206.59
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 73660 26
|
| Hospital Charge Code |
9727366001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.67
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.25
|
| Rate for Payer: United Healthcare VA CCN |
$29.25
|
|
|
XR TOE MIN 2 VIEWS
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 73660 26
|
| Hospital Charge Code |
9727366001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.11 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of VT Commercial |
$61.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$60.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.25
|
| Rate for Payer: United Healthcare Commercial |
$61.75
|
|
