|
XR FOOT COMPL MIN 3 VIEWS
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 73630 26
|
| Hospital Charge Code |
9727363001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.89 |
| 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 |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$43.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$57.24
|
| 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: Martins Point Health Care Commercial |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.40
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.40
|
| Rate for Payer: United Healthcare VA CCN |
$32.40
|
|
|
XR FOOT COMPL MIN 3 VIEWS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 73630 26
|
| Hospital Charge Code |
9727363001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$113.94 |
| Rate for Payer: Aetna of VT Commercial |
$67.68
|
| 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 |
$7.82
|
| 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 |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.79
|
| 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 |
$12.79
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$66.96
|
| 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 FOREARM 2 VIEWS
|
Facility
|
IP
|
$468.40
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
32073090RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.66 |
| Max. Negotiated Rate |
$444.98 |
| Rate for Payer: Aetna of VT Commercial |
$444.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.72
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cigna Commercial |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.72
|
| Rate for Payer: Multiplan Commercial |
$435.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.14
|
| Rate for Payer: United Healthcare Commercial |
$444.98
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
OP
|
$468.40
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
32073090LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$444.98 |
| Rate for Payer: Aetna of VT Commercial |
$444.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.38
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cigna Commercial |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$210.78
|
| Rate for Payer: Multiplan Commercial |
$435.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$210.78
|
| Rate for Payer: United Healthcare Commercial |
$444.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.78
|
| Rate for Payer: United Healthcare VA CCN |
$210.78
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 73090 26
|
| Hospital Charge Code |
9727309001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.12 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna of VT Commercial |
$64.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.06
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$63.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.60
|
| Rate for Payer: United Healthcare VA CCN |
$30.60
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
OP
|
$468.40
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
32073090RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$444.98 |
| Rate for Payer: Aetna of VT Commercial |
$444.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.38
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cigna Commercial |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$210.78
|
| Rate for Payer: Multiplan Commercial |
$435.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$210.78
|
| Rate for Payer: United Healthcare Commercial |
$444.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.78
|
| Rate for Payer: United Healthcare VA CCN |
$210.78
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
IP
|
$440.48
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
3207309001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.00 |
| Max. Negotiated Rate |
$418.46 |
| Rate for Payer: Aetna of VT Commercial |
$418.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.38
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cigna Commercial |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.38
|
| Rate for Payer: Multiplan Commercial |
$409.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.41
|
| Rate for Payer: United Healthcare Commercial |
$418.46
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 73090 26
|
| Hospital Charge Code |
9727309001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.33 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna of VT Commercial |
$64.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$57.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.40
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$63.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.80
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
|
|
XR FOREARM 2 VIEWS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
CPT 73090 26
|
| Hospital Charge Code |
9727309001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$93.71 |
| Rate for Payer: Aetna of VT Commercial |
$63.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| 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 |
$93.71
|
| 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 |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$63.24
|
| 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 FOREARM 2 VIEWS
|
Facility
|
IP
|
$468.40
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
32073090LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.66 |
| Max. Negotiated Rate |
$444.98 |
| Rate for Payer: Aetna of VT Commercial |
$444.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.72
|
| Rate for Payer: Cash Price |
$234.20
|
| Rate for Payer: Cigna Commercial |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.72
|
| Rate for Payer: Multiplan Commercial |
$435.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.14
|
| Rate for Payer: United Healthcare Commercial |
$444.98
|
|
|
XR FOREARM 2 VIEWS
|
Facility
|
OP
|
$440.48
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
3207309001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$418.46 |
| Rate for Payer: Aetna of VT Commercial |
$418.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$356.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.18
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cash Price |
$220.24
|
| Rate for Payer: Cigna Commercial |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.22
|
| Rate for Payer: Multiplan Commercial |
$409.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.22
|
| Rate for Payer: United Healthcare Commercial |
$418.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.22
|
| Rate for Payer: United Healthcare VA CCN |
$198.22
|
|
|
XR HAND 2 VIEWS
|
Facility
|
IP
|
$451.86
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
3207312001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$334.42 |
| Max. Negotiated Rate |
$429.27 |
| Rate for Payer: Aetna of VT Commercial |
$429.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.49
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cigna Commercial |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$361.49
|
| Rate for Payer: Multiplan Commercial |
$420.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.08
|
| Rate for Payer: United Healthcare Commercial |
$429.27
|
|
|
XR HAND 2 VIEWS
|
Facility
|
OP
|
$488.95
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
32073120RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Aetna of VT Commercial |
$464.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$216.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$294.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$220.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.72
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cigna Commercial |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.03
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.03
|
| Rate for Payer: United Healthcare Commercial |
$464.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.03
|
| Rate for Payer: United Healthcare VA CCN |
$220.03
|
|
|
XR HAND 2 VIEWS
|
Facility
|
IP
|
$488.95
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
32073120RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.87 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Aetna of VT Commercial |
$464.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$410.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.16
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cigna Commercial |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.16
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: United Healthcare Commercial |
$464.50
|
|
|
XR HAND 2 VIEWS
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$52.55 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.80
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
|
|
XR HAND 2 VIEWS
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna of VT Commercial |
$67.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$60.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.45
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.95
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.95
|
| Rate for Payer: United Healthcare VA CCN |
$31.95
|
|
|
XR HAND 2 VIEWS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna of VT Commercial |
$66.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| 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 |
$102.38
|
| 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 |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.08
|
| 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 |
$12.08
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| 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 HAND 2 VIEWS
|
Facility
|
OP
|
$488.95
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
32073120LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Aetna of VT Commercial |
$464.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$216.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$294.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$220.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.72
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cigna Commercial |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$220.03
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.03
|
| Rate for Payer: United Healthcare Commercial |
$464.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.03
|
| Rate for Payer: United Healthcare VA CCN |
$220.03
|
|
|
XR HAND 2 VIEWS
|
Facility
|
IP
|
$488.95
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
32073120LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.87 |
| Max. Negotiated Rate |
$464.50 |
| Rate for Payer: Aetna of VT Commercial |
$464.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$410.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.16
|
| Rate for Payer: Cash Price |
$244.48
|
| Rate for Payer: Cigna Commercial |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.16
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.61
|
| Rate for Payer: United Healthcare Commercial |
$464.50
|
|
|
XR HAND 2 VIEWS
|
Facility
|
OP
|
$451.86
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
3207312001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$429.27 |
| Rate for Payer: Aetna of VT Commercial |
$429.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$200.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$272.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$366.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$203.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$359.23
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cash Price |
$225.93
|
| Rate for Payer: Cigna Commercial |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$361.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$361.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$203.34
|
| Rate for Payer: Multiplan Commercial |
$420.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$203.34
|
| Rate for Payer: United Healthcare Commercial |
$429.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.34
|
| Rate for Payer: United Healthcare VA CCN |
$203.34
|
|
|
XR HAND BILAT 2V
|
Facility
|
IP
|
$903.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
3207312050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$668.84 |
| Max. Negotiated Rate |
$858.53 |
| Rate for Payer: Aetna of VT Commercial |
$858.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$668.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$668.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$759.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$722.98
|
| Rate for Payer: Cash Price |
$451.86
|
| Rate for Payer: Cigna Commercial |
$722.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$722.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$722.98
|
| Rate for Payer: Multiplan Commercial |
$840.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$768.16
|
| Rate for Payer: United Healthcare Commercial |
$858.53
|
|
|
XR HAND BILAT 2V
|
Facility
|
OP
|
$903.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
3207312050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$858.53 |
| Rate for Payer: Aetna of VT Commercial |
$858.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$400.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$544.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$768.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$406.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$718.46
|
| Rate for Payer: Cash Price |
$451.86
|
| Rate for Payer: Cash Price |
$451.86
|
| Rate for Payer: Cigna Commercial |
$722.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$722.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$722.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$406.67
|
| Rate for Payer: Multiplan Commercial |
$840.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$768.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$406.67
|
| Rate for Payer: United Healthcare Commercial |
$858.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$406.67
|
| Rate for Payer: United Healthcare VA CCN |
$406.67
|
|
|
XR HAND BILAT READ
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312050
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna of VT Commercial |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.38
|
| 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 |
$102.38
|
| 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 |
$12.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.08
|
| 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 |
$12.08
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$42.78
|
| 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 HAND BILAT READ
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312050
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna of VT Commercial |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$41.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$41.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.57
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$43.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.70
|
| Rate for Payer: United Healthcare VA CCN |
$20.70
|
|
|
XR HAND BILAT READ
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 73120 26
|
| Hospital Charge Code |
9727312050
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.04 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna of VT Commercial |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.80
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$42.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.10
|
| Rate for Payer: United Healthcare Commercial |
$43.70
|
|
