|
XR FINGER MIN 2 VIEWS
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 73140 26
|
| Hospital Charge Code |
9727314001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.03
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.85
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.85
|
| Rate for Payer: United Healthcare VA CCN |
$32.85
|
|
|
XR FINGER MIN 2 VIEWS
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
32073140LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.07 |
| 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 |
$137.07
|
| 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 |
$137.07
|
| 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 FINGER MIN 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
32073140LT
|
|
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 FINGER MIN 2 VIEWS
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 73140 26
|
| Hospital Charge Code |
9727314001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna of VT Commercial |
$69.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.40
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.05
|
| Rate for Payer: United Healthcare Commercial |
$69.35
|
|
|
XR FINGER MIN 2 VIEWS
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
32073140RT
|
|
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 FINGER MIN 2 VIEWS
|
Facility
|
OP
|
$459.10
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
3207314001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.07 |
| 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 |
$137.07
|
| 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 |
$137.07
|
| 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 FINGER MIN 2 VIEWS
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 73140 26
|
| Hospital Charge Code |
9727314001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$137.07 |
| Rate for Payer: Aetna of VT Commercial |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$10.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.06
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$9.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare VA CCN |
$6.30
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
OP
|
$469.44
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
3207362001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.26 |
| Max. Negotiated Rate |
$445.97 |
| Rate for Payer: Aetna of VT Commercial |
$445.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$380.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.20
|
| Rate for Payer: Cash Price |
$234.72
|
| Rate for Payer: Cash Price |
$234.72
|
| Rate for Payer: Cigna Commercial |
$375.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.25
|
| Rate for Payer: Multiplan Commercial |
$436.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.25
|
| Rate for Payer: United Healthcare Commercial |
$445.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.25
|
| Rate for Payer: United Healthcare VA CCN |
$211.25
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
OP
|
$466.85
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
32073620RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.26 |
| Max. Negotiated Rate |
$443.51 |
| Rate for Payer: Aetna of VT Commercial |
$443.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$378.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$371.15
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cigna Commercial |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$434.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$210.08
|
| Rate for Payer: United Healthcare Commercial |
$443.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.08
|
| Rate for Payer: United Healthcare VA CCN |
$210.08
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
IP
|
$466.85
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
32073620RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$443.51 |
| Rate for Payer: Aetna of VT Commercial |
$443.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$345.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$345.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.48
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cigna Commercial |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.48
|
| Rate for Payer: Multiplan Commercial |
$434.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.82
|
| Rate for Payer: United Healthcare Commercial |
$443.51
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 73620 26
|
| Hospital Charge Code |
9727362001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of VT Commercial |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.55
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$83.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.50
|
| Rate for Payer: United Healthcare VA CCN |
$40.50
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
OP
|
$466.85
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
32073620LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.26 |
| Max. Negotiated Rate |
$443.51 |
| Rate for Payer: Aetna of VT Commercial |
$443.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$378.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$371.15
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cigna Commercial |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$434.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$210.08
|
| Rate for Payer: United Healthcare Commercial |
$443.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.08
|
| Rate for Payer: United Healthcare VA CCN |
$210.08
|
|
|
XR FOOT 2 VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 73620 26
|
| Hospital Charge Code |
9727362001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$92.26 |
| Rate for Payer: Aetna of VT Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.02
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$10.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$83.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
IP
|
$469.44
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
3207362001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.43 |
| Max. Negotiated Rate |
$445.97 |
| Rate for Payer: Aetna of VT Commercial |
$445.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.55
|
| Rate for Payer: Cash Price |
$234.72
|
| Rate for Payer: Cigna Commercial |
$375.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.55
|
| Rate for Payer: Multiplan Commercial |
$436.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.02
|
| Rate for Payer: United Healthcare Commercial |
$445.97
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
IP
|
$466.85
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
32073620LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$443.51 |
| Rate for Payer: Aetna of VT Commercial |
$443.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$345.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$345.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.48
|
| Rate for Payer: Cash Price |
$233.43
|
| Rate for Payer: Cigna Commercial |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.48
|
| Rate for Payer: Multiplan Commercial |
$434.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.82
|
| Rate for Payer: United Healthcare Commercial |
$443.51
|
|
|
XR FOOT 2 VIEWS
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 73620 26
|
| Hospital Charge Code |
9727362001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna of VT Commercial |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$72.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$83.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 73630 26
|
| Hospital Charge Code |
9727363001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of VT Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$53.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$53.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$57.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$482.30
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
32073630LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.95 |
| Max. Negotiated Rate |
$458.19 |
| Rate for Payer: Aetna of VT Commercial |
$458.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.84
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.84
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.95
|
| Rate for Payer: United Healthcare Commercial |
$458.19
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$482.30
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
32073630LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$458.19 |
| Rate for Payer: Aetna of VT Commercial |
$458.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.43
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.03
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.03
|
| Rate for Payer: United Healthcare Commercial |
$458.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.03
|
| Rate for Payer: United Healthcare VA CCN |
$217.03
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Professional
|
Both
|
$482.30
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
32073630LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$453.36 |
| Rate for Payer: Aetna of VT Commercial |
$453.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: United Healthcare Commercial |
$409.95
|
| Rate for Payer: United Healthcare VA CCN |
$192.92
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$482.30
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
32073630RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.95 |
| Max. Negotiated Rate |
$458.19 |
| Rate for Payer: Aetna of VT Commercial |
$458.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$356.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$356.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.84
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.84
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.95
|
| Rate for Payer: United Healthcare Commercial |
$458.19
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$482.30
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
32073630RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$458.19 |
| Rate for Payer: Aetna of VT Commercial |
$458.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$409.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.43
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$385.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$385.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.03
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$409.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.03
|
| Rate for Payer: United Healthcare Commercial |
$458.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.03
|
| Rate for Payer: United Healthcare VA CCN |
$217.03
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$513.90
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
3207363001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$488.20 |
| Rate for Payer: Aetna of VT Commercial |
$488.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$227.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$309.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$436.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$416.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$231.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.55
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cigna Commercial |
$411.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$411.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$411.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$231.25
|
| Rate for Payer: Multiplan Commercial |
$477.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$436.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$231.25
|
| Rate for Payer: United Healthcare Commercial |
$488.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.25
|
| Rate for Payer: United Healthcare VA CCN |
$231.25
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Professional
|
Both
|
$482.30
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
32073630RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$453.36 |
| Rate for Payer: Aetna of VT Commercial |
$453.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$113.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$448.54
|
| Rate for Payer: United Healthcare Commercial |
$409.95
|
| Rate for Payer: United Healthcare VA CCN |
$192.92
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
IP
|
$513.90
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
3207363001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.34 |
| Max. Negotiated Rate |
$488.20 |
| Rate for Payer: Aetna of VT Commercial |
$488.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$436.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$431.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$411.12
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cigna Commercial |
$411.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$411.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$411.12
|
| Rate for Payer: Multiplan Commercial |
$477.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$436.81
|
| Rate for Payer: United Healthcare Commercial |
$488.20
|
|
