|
DRAIN/INJ JOINT/BURSA W/US
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
5102060401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$288.58 |
| Rate for Payer: Aetna of VT Commercial |
$288.58
|
| 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 |
$44.29
|
| 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 |
$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 |
$153.50
|
| Rate for Payer: Cash Price |
$153.50
|
| 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 |
$285.51
|
| 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
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9602061102
|
|
Hospital Revenue Code
|
960
|
| 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
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9822061101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$108.51 |
| 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 |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| 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: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
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
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9602060601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$375.97 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna of VT Commercial |
$482.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$431.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$426.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.40
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$406.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$406.40
|
| Rate for Payer: Multiplan Commercial |
$472.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$431.80
|
| Rate for Payer: United Healthcare Commercial |
$482.60
|
|
|
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
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9602060402
|
|
Hospital Revenue Code
|
960
|
| 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
|
$238.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9602060602
|
|
Hospital Revenue Code
|
960
|
| 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
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9812061102
|
|
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
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$269.80
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
4502060601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.68 |
| Max. Negotiated Rate |
$256.31 |
| Rate for Payer: Aetna of VT Commercial |
$256.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.84
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cigna Commercial |
$215.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.84
|
| Rate for Payer: Multiplan Commercial |
$250.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.33
|
| Rate for Payer: United Healthcare Commercial |
$256.31
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9822061101
|
|
Hospital Revenue Code
|
982
|
| 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
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9812061102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.51 |
| 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 |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| 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: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9602061101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$411.50 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna of VT Commercial |
$528.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$411.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$472.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$467.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.80
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.80
|
| Rate for Payer: Multiplan Commercial |
$517.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$472.60
|
| Rate for Payer: United Healthcare Commercial |
$528.20
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9812060401
|
|
Hospital Revenue Code
|
981
|
| 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
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9812060402
|
|
Hospital Revenue Code
|
981
|
| 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
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
5102061101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$293.28 |
| Rate for Payer: Aetna of VT Commercial |
$293.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$279.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.38
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$104.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.51
|
| Rate for Payer: Multiplan Commercial |
$290.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.64
|
| Rate for Payer: United Healthcare Commercial |
$84.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.64
|
| Rate for Payer: United Healthcare VA CCN |
$54.64
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9822060401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$77.71 |
| 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 |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| 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: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$269.80
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
4502060601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$256.31 |
| Rate for Payer: Aetna of VT Commercial |
$256.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.49
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cigna Commercial |
$215.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.41
|
| Rate for Payer: Multiplan Commercial |
$250.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.41
|
| Rate for Payer: United Healthcare Commercial |
$256.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.41
|
| Rate for Payer: United Healthcare VA CCN |
$121.41
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
IP
|
$306.27
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
4502060401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.67 |
| 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 |
$226.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$226.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.02
|
| 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: Multiplan Commercial |
$284.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.33
|
| Rate for Payer: United Healthcare Commercial |
$290.96
|
|
|
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
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9602060401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$386.34 |
| Rate for Payer: Aetna of VT Commercial |
$386.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| 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 |
$368.21
|
| 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 |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| 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 |
$382.23
|
| 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
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9822060601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$176.14 |
| 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 |
$176.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.40
|
| 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: Multiplan Commercial |
$221.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.30
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
5102060601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.58 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of VT Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.65
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$251.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.50
|
| Rate for Payer: United Healthcare VA CCN |
$121.50
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
5102060601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.34 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna of VT Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.89
|
| 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 |
$241.89
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| 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 |
$251.10
|
| 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
|
$411.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9602060401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.03 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Aetna of VT Commercial |
$390.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.75
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.95
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare Commercial |
$390.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare VA CCN |
$184.95
|
|
