|
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
|
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
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9602061002
|
|
Hospital Revenue Code
|
960
|
| 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
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
5102060001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.49 |
| 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 |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.60
|
| 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: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5102061001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$109.73 |
| Rate for Payer: Aetna of VT Commercial |
$94.00
|
| 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 |
$43.12
|
| 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 |
$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 |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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 |
$93.00
|
| 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
|
$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
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9812061001
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
$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
|
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
|
|
|
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
|
|
|
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
|
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
|
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
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
5102060501
|
|
Hospital Revenue Code
|
510
|
| 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/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9822061001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$131.74 |
| 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 |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.40
|
| 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: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.30
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9822061001
|
|
Hospital Revenue Code
|
982
|
| 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
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9812061001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$131.74 |
| 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 |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.40
|
| 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: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.30
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9822060501
|
|
Hospital Revenue Code
|
982
|
| 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
|
$99.26
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4502061001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.96 |
| 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 |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.91
|
| 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: Martins Point Health Care Commercial |
$44.67
|
| Rate for Payer: Multiplan Commercial |
$92.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.67
|
| Rate for Payer: United Healthcare Commercial |
$94.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.67
|
| Rate for Payer: United Healthcare VA CCN |
$44.67
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9822060501
|
|
Hospital Revenue Code
|
982
|
| 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
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060002
|
|
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
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9602060501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$473.76 |
| Rate for Payer: Aetna of VT Commercial |
$473.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$451.53
|
| 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 |
$451.53
|
| 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 |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| 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 |
$468.72
|
| 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
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060003
|
|
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
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9812061002
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
