|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna of VT Commercial |
$413.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.82
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$348.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$404.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: United Healthcare VA CCN |
$195.75
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna of VT Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.46
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$189.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.59
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$183.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare VA CCN |
$119.02
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$610.50
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
4506900001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.83 |
| Max. Negotiated Rate |
$579.98 |
| Rate for Payer: Aetna of VT Commercial |
$579.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$451.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$518.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$512.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$488.40
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cigna Commercial |
$488.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.40
|
| Rate for Payer: Multiplan Commercial |
$567.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$518.92
|
| Rate for Payer: United Healthcare Commercial |
$579.98
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$1,587.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
9816900501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,174.54 |
| Max. Negotiated Rate |
$1,507.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,507.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,174.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,174.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,348.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,333.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,269.60
|
| Rate for Payer: Cash Price |
$793.50
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,269.60
|
| Rate for Payer: Multiplan Commercial |
$1,475.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.95
|
| Rate for Payer: United Healthcare Commercial |
$1,507.65
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
5106900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$242.75 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna of VT Commercial |
$311.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.40
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.40
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.80
|
| Rate for Payer: United Healthcare Commercial |
$311.60
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$694.21 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Aetna of VT Commercial |
$891.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$694.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$797.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.40
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cigna Commercial |
$750.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$750.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$750.40
|
| Rate for Payer: Multiplan Commercial |
$872.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$797.30
|
| Rate for Payer: United Healthcare Commercial |
$891.10
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
4506900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.85 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.00
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
9822602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,091.65 |
| Max. Negotiated Rate |
$1,401.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,401.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,091.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,091.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,253.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,239.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,180.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,180.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,180.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,180.00
|
| Rate for Payer: Multiplan Commercial |
$1,371.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,253.75
|
| Rate for Payer: United Healthcare Commercial |
$1,401.25
|
|
|
DRAIN HAND TENDON SHEATH
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
9822602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$653.28 |
| Max. Negotiated Rate |
$1,401.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,401.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$887.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,253.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,194.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$663.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,172.62
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,180.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,180.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,180.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$663.75
|
| Rate for Payer: Multiplan Commercial |
$1,371.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,253.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$663.75
|
| Rate for Payer: United Healthcare Commercial |
$1,401.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$663.75
|
| Rate for Payer: United Healthcare VA CCN |
$663.75
|
|
|
DRAIN HAND TENDON SHEATH
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
9822602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$533.72 |
| Max. Negotiated Rate |
$1,386.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,386.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$549.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,321.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$747.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$812.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$812.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$613.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$812.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,008.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$533.72
|
| Rate for Payer: Multiplan Commercial |
$1,371.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$757.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$533.72
|
| Rate for Payer: United Healthcare Commercial |
$821.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$533.72
|
| Rate for Payer: United Healthcare VA CCN |
$533.72
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9602060001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.62 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9822061001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$78.84 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna of VT Commercial |
$169.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.51
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$142.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.10
|
| Rate for Payer: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.10
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.10
|
| Rate for Payer: United Healthcare VA CCN |
$80.10
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5102061001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$89.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.50
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.00
|
| Rate for Payer: United Healthcare VA CCN |
$45.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9722061001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
5102060501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna of VT Commercial |
$311.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.76
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.60
|
| Rate for Payer: United Healthcare Commercial |
$311.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.60
|
| Rate for Payer: United Healthcare VA CCN |
$147.60
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9822060501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.65
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$65.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.92
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.26
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.26
|
| Rate for Payer: United Healthcare VA CCN |
$34.26
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$327.78
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
4502060501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.17 |
| Max. Negotiated Rate |
$311.39 |
| Rate for Payer: Aetna of VT Commercial |
$311.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.59
|
| Rate for Payer: Cash Price |
$163.89
|
| Rate for Payer: Cigna Commercial |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$304.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.50
|
| Rate for Payer: United Healthcare Commercial |
$311.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.50
|
| Rate for Payer: United Healthcare VA CCN |
$147.50
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5102061001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna of VT Commercial |
$95.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
9722061001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$217.62 |
| Max. Negotiated Rate |
$677.47 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$677.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$348.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$286.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$339.13
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$370.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$400.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$400.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$248.98
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare Commercial |
$383.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.98
|
| Rate for Payer: United Healthcare VA CCN |
$248.98
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060003
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.55
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.55
|
| Rate for Payer: United Healthcare VA CCN |
$62.55
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9602060502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna of VT Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.09
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$45.90
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9602061002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$167.32 |
| Rate for Payer: Aetna of VT Commercial |
$167.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.73
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.14
|
| Rate for Payer: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.86
|
| Rate for Payer: United Healthcare Commercial |
$64.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.86
|
| Rate for Payer: United Healthcare VA CCN |
$41.86
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna of VT Commercial |
$132.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.20
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.20
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.15
|
| Rate for Payer: United Healthcare Commercial |
$132.05
|
|
