|
XR KNEE 3 VIEWS
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 73562 26
|
| Hospital Charge Code |
9727356201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$138.52 |
| Rate for Payer: Aetna of VT Commercial |
$102.46
|
| 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 |
$8.82
|
| 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 |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.61
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$13.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.56
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$13.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.56
|
| Rate for Payer: United Healthcare VA CCN |
$8.56
|
|
|
XR KNEE 3 VIEWS
|
Facility
|
IP
|
$597.65
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
3207356201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.32 |
| 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 |
$442.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$442.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$508.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$502.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$478.12
|
| 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: Multiplan Commercial |
$555.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$508.00
|
| Rate for Payer: United Healthcare Commercial |
$567.77
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 73564 26
|
| Hospital Charge Code |
9727356401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$422.06 |
| Rate for Payer: Aetna of VT Commercial |
$422.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.24
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$15.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$417.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$16.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.50
|
| Rate for Payer: United Healthcare VA CCN |
$10.50
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
OP
|
$694.67
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
32073564RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.26
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare VA CCN |
$312.60
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
IP
|
$694.67
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
32073564RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.13 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.74
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
IP
|
$694.67
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
32073564LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.13 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.74
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
OP
|
$694.67
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
32073564LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.26
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare VA CCN |
$312.60
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
OP
|
$846.85
|
|
|
Service Code
|
CPT 73564 50
|
| Hospital Charge Code |
3207356450
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$804.51 |
| Rate for Payer: Aetna of VT Commercial |
$804.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$375.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$509.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$685.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$381.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$673.25
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cigna Commercial |
$677.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$381.08
|
| Rate for Payer: Multiplan Commercial |
$787.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.08
|
| Rate for Payer: United Healthcare Commercial |
$804.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.08
|
| Rate for Payer: United Healthcare VA CCN |
$381.08
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
IP
|
$846.85
|
|
|
Service Code
|
CPT 73564 50
|
| Hospital Charge Code |
3207356450
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$626.75 |
| Max. Negotiated Rate |
$804.51 |
| Rate for Payer: Aetna of VT Commercial |
$804.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$626.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$719.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$711.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$677.48
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cigna Commercial |
$677.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$677.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$677.48
|
| Rate for Payer: Multiplan Commercial |
$787.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$719.82
|
| Rate for Payer: United Healthcare Commercial |
$804.51
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 73564 26
|
| Hospital Charge Code |
9727356401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna of VT Commercial |
$426.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$381.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$359.20
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$359.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.20
|
| Rate for Payer: Multiplan Commercial |
$417.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.65
|
| Rate for Payer: United Healthcare Commercial |
$426.55
|
|
|
XR KNEE COMPL 4/> VIEWS
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 73564 26
|
| Hospital Charge Code |
9727356401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$198.86 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna of VT Commercial |
$426.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$402.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$198.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$402.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$381.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$363.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$202.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.95
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$359.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$359.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$359.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$202.05
|
| Rate for Payer: Multiplan Commercial |
$417.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$381.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.05
|
| Rate for Payer: United Healthcare Commercial |
$426.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.05
|
| Rate for Payer: United Healthcare VA CCN |
$202.05
|
|
|
XR KNEE COMPL 4/> VIEWS BILATE
|
Facility
|
OP
|
$694.67
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
3207356401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$562.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$312.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$552.26
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$312.60
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.60
|
| Rate for Payer: United Healthcare VA CCN |
$312.60
|
|
|
XR KNEE COMPL 4/> VIEWS BILATE
|
Facility
|
IP
|
$694.67
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
3207356401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.13 |
| Max. Negotiated Rate |
$659.94 |
| Rate for Payer: Aetna of VT Commercial |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$514.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$555.74
|
| Rate for Payer: Cash Price |
$347.34
|
| Rate for Payer: Cigna Commercial |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$555.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$555.74
|
| Rate for Payer: Multiplan Commercial |
$646.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$590.47
|
| Rate for Payer: United Healthcare Commercial |
$659.94
|
|
|
XR KNEES BOTH STAND ANTEROPOST
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 73565 26
|
| Hospital Charge Code |
9727356501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Aetna of VT Commercial |
$161.68
|
| 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 |
$8.15
|
| 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 |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.44
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.91
|
| Rate for Payer: United Healthcare Commercial |
$12.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.91
|
| Rate for Payer: United Healthcare VA CCN |
$7.91
|
|
|
XR KNEES BOTH STAND ANTEROPOST
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 73565 26
|
| Hospital Charge Code |
9727356501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna of VT Commercial |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.60
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.60
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.20
|
| Rate for Payer: United Healthcare Commercial |
$163.40
|
|
|
XR KNEES BOTH STAND ANTEROPOST
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 73565 26
|
| Hospital Charge Code |
9727356501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$76.18 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna of VT Commercial |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$103.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.74
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.40
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.40
|
| Rate for Payer: United Healthcare Commercial |
$163.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.40
|
| Rate for Payer: United Healthcare VA CCN |
$77.40
|
|
|
XR KNEES BOTH STAND ANTEROPOST
|
Facility
|
OP
|
$475.64
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
3207356501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$451.86 |
| Rate for Payer: Aetna of VT Commercial |
$451.86
|
| 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 |
$210.66
|
| 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 |
$286.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$385.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.13
|
| Rate for Payer: Cash Price |
$237.82
|
| Rate for Payer: Cash Price |
$237.82
|
| Rate for Payer: Cigna Commercial |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$214.04
|
| Rate for Payer: Multiplan Commercial |
$442.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.04
|
| Rate for Payer: United Healthcare Commercial |
$451.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.04
|
| Rate for Payer: United Healthcare VA CCN |
$214.04
|
|
|
XR KNEES BOTH STAND ANTEROPOST
|
Facility
|
IP
|
$475.64
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
3207356501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.02 |
| Max. Negotiated Rate |
$451.86 |
| Rate for Payer: Aetna of VT Commercial |
$451.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$404.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$399.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$380.51
|
| Rate for Payer: Cash Price |
$237.82
|
| Rate for Payer: Cigna Commercial |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$380.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$380.51
|
| Rate for Payer: Multiplan Commercial |
$442.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.29
|
| Rate for Payer: United Healthcare Commercial |
$451.86
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$349.18
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
32073592RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.34
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 73592 26
|
| Hospital Charge Code |
9727359201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$349.18
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
32073592RT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.13
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare VA CCN |
$157.13
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Facility
|
IP
|
$349.18
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
32073592LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.43 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$279.34
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 73592 26
|
| Hospital Charge Code |
9727359201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$73.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.59
|
| 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 |
$12.59
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.27
|
| Rate for Payer: United Healthcare VA CCN |
$7.27
|
|
|
XR LOWER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
3207359201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$103.83 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$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 LOWER EXTREM INF MIN 2 VWS
|
Facility
|
OP
|
$349.18
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
32073592LT
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.83 |
| Max. Negotiated Rate |
$331.72 |
| Rate for Payer: Aetna of VT Commercial |
$331.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.60
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cash Price |
$174.59
|
| Rate for Payer: Cigna Commercial |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$279.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$279.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$157.13
|
| Rate for Payer: Multiplan Commercial |
$324.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare Commercial |
$331.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.13
|
| Rate for Payer: United Healthcare VA CCN |
$157.13
|
|
