|
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
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9602060002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9812060002
|
|
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
|
$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
|
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
|
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
|
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 |
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
|
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
|
$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
|
OP
|
$101.33
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
4502060001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.88 |
| 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 |
$90.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.56
|
| 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: Martins Point Health Care Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$94.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.60
|
| Rate for Payer: United Healthcare Commercial |
$96.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.60
|
| Rate for Payer: United Healthcare VA CCN |
$45.60
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9602060501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$373.01 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of VT Commercial |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$373.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$373.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.20
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$403.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.20
|
| Rate for Payer: Multiplan Commercial |
$468.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9812060501
|
|
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
|
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 |
9812061002
|
|
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
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9812060502
|
|
Hospital Revenue Code
|
981
|
| 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
|
$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
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9812060501
|
|
Hospital Revenue Code
|
981
|
| 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
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9812060501
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
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/US
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9602060601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$477.52 |
| Rate for Payer: Aetna of VT Commercial |
$477.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$455.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.88
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$91.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.96
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.34
|
| Rate for Payer: United Healthcare Commercial |
$74.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.34
|
| Rate for Payer: United Healthcare VA CCN |
$48.34
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9812060602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna of VT Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.21
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.10
|
| Rate for Payer: United Healthcare VA CCN |
$107.10
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$306.27
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
4502060401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.65 |
| Max. Negotiated Rate |
$290.96 |
| Rate for Payer: Aetna of VT Commercial |
$290.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$274.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$274.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$184.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$137.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$243.48
|
| Rate for Payer: Cash Price |
$153.14
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$137.82
|
| Rate for Payer: Multiplan Commercial |
$284.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$137.82
|
| Rate for Payer: United Healthcare Commercial |
$290.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.82
|
| Rate for Payer: United Healthcare VA CCN |
$137.82
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9812061101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
