|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900002
|
|
Hospital Revenue Code
|
981
|
| 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
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900002
|
|
Hospital Revenue Code
|
981
|
| 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 EXTERNAL EAR LESION
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$881.72 |
| Rate for Payer: Aetna of VT Commercial |
$881.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$840.35
|
| 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 |
$840.35
|
| 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 |
$469.00
|
| Rate for Payer: Cash Price |
$469.00
|
| 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 |
$872.34
|
| 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
|
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
|
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
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
4506900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.16 |
| 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 |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$380.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.65
|
| 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: Martins Point Health Care Commercial |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare VA CCN |
$211.50
|
|
|
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
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900002
|
|
Hospital Revenue Code
|
960
|
| 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 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
|
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 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/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
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
5102060501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.26 |
| 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 |
$35.29
|
| 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 |
$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 |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| 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 |
$305.04
|
| 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
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9602060502
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9812061001
|
|
Hospital Revenue Code
|
981
|
| 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
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9602060001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna of VT Commercial |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.47
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare Commercial |
$51.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare VA CCN |
$33.29
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9812060502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.26 |
| 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 |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| 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: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9602060001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.30 |
| 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 |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.80
|
| 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: Martins Point Health Care Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare VA CCN |
$108.00
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna of VT Commercial |
$95.88
|
| 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 |
$34.29
|
| 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 |
$46.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.47
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare Commercial |
$51.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare VA CCN |
$33.29
|
|
|
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
|
$278.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9602061001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.13 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna of VT Commercial |
$264.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$221.01
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$222.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$125.10
|
| Rate for Payer: Multiplan Commercial |
$258.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$125.10
|
| Rate for Payer: United Healthcare Commercial |
$264.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.10
|
| Rate for Payer: United Healthcare VA CCN |
$125.10
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$99.26
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4502061001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$94.30 |
| Rate for Payer: Aetna of VT Commercial |
$94.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.41
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$92.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.37
|
| Rate for Payer: United Healthcare Commercial |
$94.30
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9812061002
|
|
Hospital Revenue Code
|
981
|
| 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
|
$101.33
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
4502060001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$96.26 |
| Rate for Payer: Aetna of VT Commercial |
$96.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.06
|
| Rate for Payer: Cash Price |
$50.66
|
| Rate for Payer: Cigna Commercial |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.06
|
| Rate for Payer: Multiplan Commercial |
$94.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.13
|
| Rate for Payer: United Healthcare Commercial |
$96.26
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060003
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$130.66 |
| Rate for Payer: Aetna of VT Commercial |
$130.66
|
| 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 |
$34.29
|
| 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 |
$46.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.47
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$83.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$83.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.95
|
| Rate for Payer: Multiplan Commercial |
$129.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare Commercial |
$51.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.29
|
| Rate for Payer: United Healthcare VA CCN |
$33.29
|
|
