|
XR TOE MIN 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 73660 RT
|
| Hospital Charge Code |
32073660RT
|
|
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 UPPER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 73092 26
|
| Hospital Charge Code |
9727309201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$349.18
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
32073092RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| 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 |
$154.65
|
| 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 |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.13
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare VA CCN |
$157.13
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$349.18
|
|
|
Service Code
|
CPT 73092 LT
|
| Hospital Charge Code |
32073092LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| 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 |
$154.65
|
| 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 |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.13
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare VA CCN |
$157.13
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$349.18
|
|
|
Service Code
|
CPT 73092 LT
|
| Hospital Charge Code |
32073092LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.34
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$349.18
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
32073092RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.34
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 73092 26
|
| Hospital Charge Code |
9727309201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$595.58
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
3207309201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna of VT Commercial |
$565.80
|
| 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 |
$263.78
|
| 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 |
$358.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$506.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$482.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$473.49
|
| Rate for Payer: Cash Price |
$297.79
|
| Rate for Payer: Cash Price |
$297.79
|
| Rate for Payer: Cigna Commercial |
$476.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$268.01
|
| Rate for Payer: Multiplan Commercial |
$553.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$268.01
|
| Rate for Payer: United Healthcare Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$268.01
|
| Rate for Payer: United Healthcare VA CCN |
$268.01
|
|
|
XR UPPER EXTREM INF MIN 2 VWS
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 73092 26
|
| Hospital Charge Code |
9727309201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| 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 |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| 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 UPPER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$595.58
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
3207309201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$440.79 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna of VT Commercial |
$565.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$506.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$500.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$476.46
|
| Rate for Payer: Cash Price |
$297.79
|
| Rate for Payer: Cigna Commercial |
$476.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.46
|
| Rate for Payer: Multiplan Commercial |
$553.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$506.24
|
| Rate for Payer: United Healthcare Commercial |
$565.80
|
|
|
XR URETHROCYSTOGRPH RETROG S&I
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 74450 26
|
| Hospital Charge Code |
9727445001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$139.14 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna of VT Commercial |
$178.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.40
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$150.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.40
|
| Rate for Payer: Multiplan Commercial |
$174.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.80
|
| Rate for Payer: United Healthcare Commercial |
$178.60
|
|
|
XR URETHROCYSTOGRPH RETROG S&I
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 74450 26
|
| Hospital Charge Code |
9727445001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna of VT Commercial |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,030.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.29
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$22.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.70
|
| Rate for Payer: Multiplan Commercial |
$174.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$22.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.70
|
| Rate for Payer: United Healthcare VA CCN |
$14.70
|
|
|
XR URETHROCYSTOGRPH RETROG S&I
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 74450 26
|
| Hospital Charge Code |
9727445001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$83.27 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna of VT Commercial |
$178.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.46
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$150.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$174.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$84.60
|
| Rate for Payer: United Healthcare Commercial |
$178.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.60
|
| Rate for Payer: United Healthcare VA CCN |
$84.60
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 73100 26
|
| Hospital Charge Code |
9727310001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.85
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare VA CCN |
$31.05
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
32073100LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.36
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.75
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare VA CCN |
$197.75
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
32073100RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$194.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$264.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$197.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.36
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$197.75
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.75
|
| Rate for Payer: United Healthcare VA CCN |
$197.75
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
OP
|
$446.69
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
3207310001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$424.36 |
| Rate for Payer: Aetna of VT Commercial |
$424.36
|
| 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 |
$197.84
|
| 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 |
$268.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.12
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cigna Commercial |
$357.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$357.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$357.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.01
|
| Rate for Payer: Multiplan Commercial |
$415.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.01
|
| Rate for Payer: United Healthcare Commercial |
$424.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.01
|
| Rate for Payer: United Healthcare VA CCN |
$201.01
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
32073100LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
32073100RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.24 |
| Max. Negotiated Rate |
$417.48 |
| Rate for Payer: Aetna of VT Commercial |
$417.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$325.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.56
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: Cigna Commercial |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$351.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$351.56
|
| Rate for Payer: Multiplan Commercial |
$408.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.53
|
| Rate for Payer: United Healthcare Commercial |
$417.48
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 73100 26
|
| Hospital Charge Code |
9727310001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.20
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
|
|
XR WRIST 2 VIEWS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 73100 26
|
| Hospital Charge Code |
9727310001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$112.49 |
| Rate for Payer: Aetna of VT Commercial |
$64.86
|
| 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 |
$7.82
|
| 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 |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.13
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$11.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare VA CCN |
$7.59
|
|
|
XR WRIST 2 VIEWS
|
Facility
|
IP
|
$446.69
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
3207310001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$424.36 |
| Rate for Payer: Aetna of VT Commercial |
$424.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$357.35
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cigna Commercial |
$357.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$357.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$357.35
|
| Rate for Payer: Multiplan Commercial |
$415.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$379.69
|
| Rate for Payer: United Healthcare Commercial |
$424.36
|
|
|
XR WRIST COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$557.33
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
3207311001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$412.48 |
| Max. Negotiated Rate |
$529.46 |
| Rate for Payer: Aetna of VT Commercial |
$529.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$412.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$412.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$473.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$468.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$445.86
|
| Rate for Payer: Cash Price |
$278.66
|
| Rate for Payer: Cigna Commercial |
$445.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$445.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$445.86
|
| Rate for Payer: Multiplan Commercial |
$518.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$473.73
|
| Rate for Payer: United Healthcare Commercial |
$529.46
|
|
|
XR WRIST COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$521.55
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
32073110LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$417.24
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
|
|
XR WRIST COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$521.55
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
32073110LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.83 |
| Max. Negotiated Rate |
$495.47 |
| Rate for Payer: Aetna of VT Commercial |
$495.47
|
| 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 |
$230.99
|
| 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 |
$313.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$443.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.63
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cash Price |
$260.78
|
| Rate for Payer: Cigna Commercial |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$417.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$417.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.70
|
| Rate for Payer: Multiplan Commercial |
$485.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$443.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare Commercial |
$495.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.70
|
| Rate for Payer: United Healthcare VA CCN |
$234.70
|
|
