|
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
|
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
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9602061001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$205.75 |
| 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 |
$205.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$236.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$222.40
|
| 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: Multiplan Commercial |
$258.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.30
|
| Rate for Payer: United Healthcare Commercial |
$264.10
|
|
|
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
|
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
|
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
|
$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
|
$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
|
$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
|
$504.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9602060501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$223.22 |
| 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 |
$451.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$223.22
|
| 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 |
$303.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.68
|
| 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: Martins Point Health Care Commercial |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$468.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.80
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.80
|
| Rate for Payer: United Healthcare VA CCN |
$226.80
|
|
|
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
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
9602061002
|
|
Hospital Revenue Code
|
960
|
| 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
|
$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
|
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
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9602060002
|
|
Hospital Revenue Code
|
960
|
| 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 |
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
|
$176.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9822060501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.65
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$65.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.92
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.26
|
| Rate for Payer: United Healthcare Commercial |
$52.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.26
|
| Rate for Payer: United Healthcare VA CCN |
$34.26
|
|
|
DRAIN/INJ JOINT/BURSA W/O US
|
Facility
|
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
|
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
|
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/US
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9812060601
|
|
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
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9822060401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$128.58 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.93
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$80.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.66
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$66.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.00
|
| Rate for Payer: United Healthcare VA CCN |
$43.00
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9602060402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
5102060401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.97 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna of VT Commercial |
$291.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$184.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$244.06
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.15
|
| Rate for Payer: Multiplan Commercial |
$285.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.15
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.15
|
| Rate for Payer: United Healthcare VA CCN |
$138.15
|
|
