|
XR JAW JOINT UNILAT
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
3207032801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$112.49 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 70328 26
|
| Hospital Charge Code |
9727032801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.20
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
|
|
XR JAW JOINT UNILAT
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 70328 26
|
| Hospital Charge Code |
9727032801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$112.49 |
| Rate for Payer: Aetna of VT Commercial |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.88
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$12.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$8.24
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
OP
|
$470.47
|
|
|
Service Code
|
CPT 70328 LT
|
| Hospital Charge Code |
32070328LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$446.95 |
| Rate for Payer: Aetna of VT Commercial |
$446.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.02
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cigna Commercial |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.71
|
| Rate for Payer: Multiplan Commercial |
$437.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.71
|
| Rate for Payer: United Healthcare Commercial |
$446.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.71
|
| Rate for Payer: United Healthcare VA CCN |
$211.71
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
IP
|
$470.47
|
|
|
Service Code
|
CPT 70328 LT
|
| Hospital Charge Code |
32070328LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.19 |
| Max. Negotiated Rate |
$446.95 |
| Rate for Payer: Aetna of VT Commercial |
$446.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$395.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.38
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cigna Commercial |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.38
|
| Rate for Payer: Multiplan Commercial |
$437.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.90
|
| Rate for Payer: United Healthcare Commercial |
$446.95
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
3207032801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
OP
|
$470.47
|
|
|
Service Code
|
CPT 70328 RT
|
| Hospital Charge Code |
32070328RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.49 |
| Max. Negotiated Rate |
$446.95 |
| Rate for Payer: Aetna of VT Commercial |
$446.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$283.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$381.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.02
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cigna Commercial |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.71
|
| Rate for Payer: Multiplan Commercial |
$437.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.71
|
| Rate for Payer: United Healthcare Commercial |
$446.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.71
|
| Rate for Payer: United Healthcare VA CCN |
$211.71
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 70328 26
|
| Hospital Charge Code |
9727032801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna of VT Commercial |
$98.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$96.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare Commercial |
$98.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.80
|
| Rate for Payer: United Healthcare VA CCN |
$46.80
|
|
|
XR JAW JOINT UNILAT
|
Facility
|
IP
|
$470.47
|
|
|
Service Code
|
CPT 70328 RT
|
| Hospital Charge Code |
32070328RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.19 |
| Max. Negotiated Rate |
$446.95 |
| Rate for Payer: Aetna of VT Commercial |
$446.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$395.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.38
|
| Rate for Payer: Cash Price |
$235.24
|
| Rate for Payer: Cigna Commercial |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.38
|
| Rate for Payer: Multiplan Commercial |
$437.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.90
|
| Rate for Payer: United Healthcare Commercial |
$446.95
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 73560 26
|
| Hospital Charge Code |
9727356001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$88.07 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna of VT Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.20
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.20
|
| Rate for Payer: Multiplan Commercial |
$110.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.15
|
| Rate for Payer: United Healthcare Commercial |
$113.05
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
OP
|
$497.35
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
3207356001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$472.48 |
| Rate for Payer: Aetna of VT Commercial |
$472.48
|
| 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 |
$220.28
|
| 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 |
$299.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$402.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$395.39
|
| Rate for Payer: Cash Price |
$248.68
|
| Rate for Payer: Cash Price |
$248.68
|
| Rate for Payer: Cigna Commercial |
$397.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.81
|
| Rate for Payer: Multiplan Commercial |
$462.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$422.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$223.81
|
| Rate for Payer: United Healthcare Commercial |
$472.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.81
|
| Rate for Payer: United Healthcare VA CCN |
$223.81
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
IP
|
$497.35
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
3207356001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.09 |
| Max. Negotiated Rate |
$472.48 |
| Rate for Payer: Aetna of VT Commercial |
$472.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$397.88
|
| Rate for Payer: Cash Price |
$248.68
|
| Rate for Payer: Cigna Commercial |
$397.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$397.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$462.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$422.75
|
| Rate for Payer: United Healthcare Commercial |
$472.48
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
OP
|
$388.78
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
32073560RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$369.34 |
| Rate for Payer: Aetna of VT Commercial |
$369.34
|
| 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 |
$172.19
|
| 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 |
$234.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.08
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cigna Commercial |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.95
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.95
|
| Rate for Payer: United Healthcare Commercial |
$369.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.95
|
| Rate for Payer: United Healthcare VA CCN |
$174.95
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
IP
|
$388.78
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
32073560LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$369.34 |
| Rate for Payer: Aetna of VT Commercial |
$369.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.02
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cigna Commercial |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.02
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.46
|
| Rate for Payer: United Healthcare Commercial |
$369.34
|
|
|
XR KNEE 1/2 VIEWS
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 73560 26
|
| Hospital Charge Code |
9727356001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$113.94 |
| Rate for Payer: Aetna of VT Commercial |
$111.86
|
| 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 |
$12.08
|
| 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 |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$110.67
|
| 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 KNEE 1/2 VIEWS
|
Facility
|
OP
|
$388.78
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
32073560LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$369.34 |
| Rate for Payer: Aetna of VT Commercial |
$369.34
|
| 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 |
$172.19
|
| 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 |
$234.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$314.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$174.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.08
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cigna Commercial |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.95
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$174.95
|
| Rate for Payer: United Healthcare Commercial |
$369.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.95
|
| Rate for Payer: United Healthcare VA CCN |
$174.95
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
IP
|
$388.78
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
32073560RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.74 |
| Max. Negotiated Rate |
$369.34 |
| Rate for Payer: Aetna of VT Commercial |
$369.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.02
|
| Rate for Payer: Cash Price |
$194.39
|
| Rate for Payer: Cigna Commercial |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.02
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.46
|
| Rate for Payer: United Healthcare Commercial |
$369.34
|
|
|
XR KNEE 1/2 VIEWS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 73560 26
|
| Hospital Charge Code |
9727356001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$52.71 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna of VT Commercial |
$113.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.61
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.55
|
| Rate for Payer: Multiplan Commercial |
$110.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.55
|
| Rate for Payer: United Healthcare Commercial |
$113.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.55
|
| Rate for Payer: United Healthcare VA CCN |
$53.55
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
OP
|
$482.62
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
32073562RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.68
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.18
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare VA CCN |
$217.18
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 73562 26
|
| Hospital Charge Code |
9727356201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.66
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.05
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.05
|
| Rate for Payer: United Healthcare VA CCN |
$49.05
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
OP
|
$482.62
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
32073562LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$390.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.68
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.18
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.18
|
| Rate for Payer: United Healthcare VA CCN |
$217.18
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
IP
|
$482.62
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
32073562LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.19 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.10
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 73562 26
|
| Hospital Charge Code |
9727356201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.20
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
OP
|
$597.65
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
3207356201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$567.77 |
| Rate for Payer: Aetna of VT Commercial |
$567.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$359.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$484.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$268.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.13
|
| Rate for Payer: Cash Price |
$298.82
|
| Rate for Payer: Cash Price |
$298.82
|
| Rate for Payer: Cigna Commercial |
$478.12
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$268.94
|
| Rate for Payer: Multiplan Commercial |
$555.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$268.94
|
| Rate for Payer: United Healthcare Commercial |
$567.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$268.94
|
| Rate for Payer: United Healthcare VA CCN |
$268.94
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
IP
|
$482.62
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
32073562RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.19 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna of VT Commercial |
$458.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.10
|
| Rate for Payer: Cash Price |
$241.31
|
| Rate for Payer: Cigna Commercial |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$448.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.23
|
| Rate for Payer: United Healthcare Commercial |
$458.49
|
|
