|
SHOE DARCO W LG
|
Professional
|
Both
|
$43.21
|
|
| Hospital Charge Code |
2740032811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna of VT Commercial |
$40.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: United Healthcare Commercial |
$36.73
|
| Rate for Payer: United Healthcare VA CCN |
$17.28
|
|
|
SHOE DARCO W LG
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.35
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare VA CCN |
$19.44
|
|
|
SHOE DARCO W LG
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.57
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
|
|
SHOE DARCO W M
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.35
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.44
|
| Rate for Payer: United Healthcare VA CCN |
$19.44
|
|
|
SHOE DARCO W M
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$41.05 |
| Rate for Payer: Aetna of VT Commercial |
$41.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.57
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.73
|
| Rate for Payer: United Healthcare Commercial |
$41.05
|
|
|
SHOE DARCO W M
|
Professional
|
Both
|
$43.21
|
|
| Hospital Charge Code |
2740021261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$40.62 |
| Rate for Payer: Aetna of VT Commercial |
$40.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.71
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$40.19
|
| Rate for Payer: United Healthcare Commercial |
$36.73
|
| Rate for Payer: United Healthcare VA CCN |
$17.28
|
|
|
SHOE DARCO W SM
|
Facility
|
IP
|
$62.43
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.31 |
| Rate for Payer: Aetna of VT Commercial |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.94
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.07
|
| Rate for Payer: United Healthcare Commercial |
$59.31
|
|
|
SHOE DARCO W SM
|
Facility
|
OP
|
$62.43
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740032801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$59.31 |
| Rate for Payer: Aetna of VT Commercial |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.63
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.09
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.09
|
| Rate for Payer: United Healthcare Commercial |
$59.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.09
|
| Rate for Payer: United Healthcare VA CCN |
$28.09
|
|
|
SHOE DARCO W SM
|
Professional
|
Both
|
$62.43
|
|
| Hospital Charge Code |
2740032801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$58.68 |
| Rate for Payer: Aetna of VT Commercial |
$58.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.93
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Multiplan Commercial |
$58.06
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: United Healthcare VA CCN |
$24.97
|
|
|
SHOE ORTHO WEDGE LG
|
Professional
|
Both
|
$117.69
|
|
| Hospital Charge Code |
2740021301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$110.63 |
| Rate for Payer: Aetna of VT Commercial |
$110.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.44
|
| Rate for Payer: Cash Price |
$58.84
|
| Rate for Payer: Multiplan Commercial |
$109.45
|
| Rate for Payer: United Healthcare Commercial |
$100.04
|
| Rate for Payer: United Healthcare VA CCN |
$47.08
|
|
|
SHOE ORTHO WEDGE LG
|
Facility
|
IP
|
$117.69
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$111.81 |
| Rate for Payer: Aetna of VT Commercial |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.15
|
| Rate for Payer: Cash Price |
$58.84
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.15
|
| Rate for Payer: Multiplan Commercial |
$109.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.04
|
| Rate for Payer: United Healthcare Commercial |
$111.81
|
|
|
SHOE ORTHO WEDGE LG
|
Facility
|
OP
|
$117.69
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$111.81 |
| Rate for Payer: Aetna of VT Commercial |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.56
|
| Rate for Payer: Cash Price |
$58.84
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.96
|
| Rate for Payer: Multiplan Commercial |
$109.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.96
|
| Rate for Payer: United Healthcare Commercial |
$111.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.96
|
| Rate for Payer: United Healthcare VA CCN |
$52.96
|
|
|
SHOE ORTHO WEDGE MD
|
Facility
|
OP
|
$154.93
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740033261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$147.18 |
| Rate for Payer: Aetna of VT Commercial |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.17
|
| Rate for Payer: Cash Price |
$77.47
|
| Rate for Payer: Cigna Commercial |
$123.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.72
|
| Rate for Payer: Multiplan Commercial |
$144.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.72
|
| Rate for Payer: United Healthcare Commercial |
$147.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.72
|
| Rate for Payer: United Healthcare VA CCN |
$69.72
|
|
|
SHOE ORTHO WEDGE MD
|
Professional
|
Both
|
$154.93
|
|
| Hospital Charge Code |
2740033261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$145.63 |
| Rate for Payer: Aetna of VT Commercial |
$145.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.80
|
| Rate for Payer: Cash Price |
$77.47
|
| Rate for Payer: Multiplan Commercial |
$144.08
|
| Rate for Payer: United Healthcare Commercial |
$131.69
|
| Rate for Payer: United Healthcare VA CCN |
$61.97
|
|
|
SHOE ORTHO WEDGE MD
|
Facility
|
IP
|
$154.93
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740033261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$147.18 |
| Rate for Payer: Aetna of VT Commercial |
$147.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.94
|
| Rate for Payer: Cash Price |
$77.47
|
| Rate for Payer: Cigna Commercial |
$123.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.94
|
| Rate for Payer: Multiplan Commercial |
$144.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.69
|
| Rate for Payer: United Healthcare Commercial |
$147.18
|
|
|
SHOE ORTHO WEDGE SM
|
Facility
|
OP
|
$93.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021291
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$88.61 |
| Rate for Payer: Aetna of VT Commercial |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.15
|
| Rate for Payer: Cash Price |
$46.63
|
| Rate for Payer: Cigna Commercial |
$74.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.97
|
| Rate for Payer: Multiplan Commercial |
$86.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.97
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.97
|
| Rate for Payer: United Healthcare VA CCN |
$41.97
|
|
|
SHOE ORTHO WEDGE SM
|
Facility
|
IP
|
$93.27
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021291
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$88.61 |
| Rate for Payer: Aetna of VT Commercial |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.62
|
| Rate for Payer: Cash Price |
$46.63
|
| Rate for Payer: Cigna Commercial |
$74.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.62
|
| Rate for Payer: Multiplan Commercial |
$86.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.28
|
| Rate for Payer: United Healthcare Commercial |
$88.61
|
|
|
SHOE ORTHO WEDGE SM
|
Professional
|
Both
|
$93.27
|
|
| Hospital Charge Code |
2740021291
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$87.67 |
| Rate for Payer: Aetna of VT Commercial |
$87.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.56
|
| Rate for Payer: Cash Price |
$46.63
|
| Rate for Payer: Multiplan Commercial |
$86.74
|
| Rate for Payer: United Healthcare Commercial |
$79.28
|
| Rate for Payer: United Healthcare VA CCN |
$37.31
|
|
|
SHOE ORTHO WEDGE XL
|
Facility
|
IP
|
$124.37
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Aetna of VT Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.50
|
| Rate for Payer: Cash Price |
$62.19
|
| Rate for Payer: Cigna Commercial |
$99.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$115.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.71
|
| Rate for Payer: United Healthcare Commercial |
$118.15
|
|
|
SHOE ORTHO WEDGE XL
|
Facility
|
OP
|
$124.37
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2740021311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Aetna of VT Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.87
|
| Rate for Payer: Cash Price |
$62.19
|
| Rate for Payer: Cigna Commercial |
$99.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$115.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.97
|
| Rate for Payer: United Healthcare Commercial |
$118.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.97
|
| Rate for Payer: United Healthcare VA CCN |
$55.97
|
|
|
SHOE ORTHO WEDGE XL
|
Professional
|
Both
|
$124.37
|
|
| Hospital Charge Code |
2740021311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna of VT Commercial |
$116.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.42
|
| Rate for Payer: Cash Price |
$62.19
|
| Rate for Payer: Multiplan Commercial |
$115.66
|
| Rate for Payer: United Healthcare Commercial |
$105.71
|
| Rate for Payer: United Healthcare VA CCN |
$49.75
|
|
|
SHOE PO CLASSIC M XXL
|
Professional
|
Both
|
$32.52
|
|
| Hospital Charge Code |
2740052421
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$30.57 |
| Rate for Payer: Aetna of VT Commercial |
$30.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.13
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$30.24
|
| Rate for Payer: United Healthcare Commercial |
$27.64
|
| Rate for Payer: United Healthcare VA CCN |
$13.01
|
|
|
SHOE PO CLASSIC M XXL
|
Facility
|
OP
|
$32.52
|
|
| Hospital Charge Code |
2740052421
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$30.89 |
| Rate for Payer: Aetna of VT Commercial |
$30.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.85
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna Commercial |
$26.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.63
|
| Rate for Payer: Multiplan Commercial |
$30.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.63
|
| Rate for Payer: United Healthcare Commercial |
$30.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.63
|
| Rate for Payer: United Healthcare VA CCN |
$14.63
|
|
|
SHOE PO CLASSIC M XXL
|
Facility
|
IP
|
$32.52
|
|
| Hospital Charge Code |
2740052421
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$30.89 |
| Rate for Payer: Aetna of VT Commercial |
$30.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.02
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna Commercial |
$26.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.02
|
| Rate for Payer: Multiplan Commercial |
$30.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.64
|
| Rate for Payer: United Healthcare Commercial |
$30.89
|
|
|
SHOULDER DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
9812303002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$418.10 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Aetna of VT Commercial |
$896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$418.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$845.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$568.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$802.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$764.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.48
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$877.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$802.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare Commercial |
$896.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.80
|
| Rate for Payer: United Healthcare VA CCN |
$424.80
|
|
