|
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
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
5102060401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$227.21 |
| 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 |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$257.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.60
|
| 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: Multiplan Commercial |
$285.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$260.95
|
| Rate for Payer: United Healthcare Commercial |
$291.65
|
|
|
DRAIN/INJ JOINT/BURSA W/US
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
9812061101
|
|
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
|
$238.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
9812060601
|
|
Hospital Revenue Code
|
981
|
| 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
|
$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
|
$105.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
9812060402
|
|
Hospital Revenue Code
|
981
|
| 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 OUTER EAR CANAL LESION
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.66
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.05
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare VA CCN |
$139.05
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$746.20
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$552.26 |
| Max. Negotiated Rate |
$708.89 |
| Rate for Payer: Aetna of VT Commercial |
$708.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$552.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$552.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$634.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$626.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$596.96
|
| Rate for Payer: Cash Price |
$373.10
|
| Rate for Payer: Cigna Commercial |
$596.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.96
|
| Rate for Payer: Multiplan Commercial |
$693.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$634.27
|
| Rate for Payer: United Healthcare Commercial |
$708.89
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9826902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9826902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$353.33 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$353.33 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$746.20
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.49 |
| Max. Negotiated Rate |
$708.89 |
| Rate for Payer: Aetna of VT Commercial |
$708.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$668.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$668.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$634.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$604.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$335.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.23
|
| Rate for Payer: Cash Price |
$373.10
|
| Rate for Payer: Cigna Commercial |
$596.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$335.79
|
| Rate for Payer: Multiplan Commercial |
$693.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$634.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$335.79
|
| Rate for Payer: United Healthcare Commercial |
$708.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.79
|
| Rate for Payer: United Healthcare VA CCN |
$335.79
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$552.85 |
| Max. Negotiated Rate |
$709.65 |
| Rate for Payer: Aetna of VT Commercial |
$709.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$552.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$552.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$634.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$597.60
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$597.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$597.60
|
| Rate for Payer: Multiplan Commercial |
$694.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$634.95
|
| Rate for Payer: United Healthcare Commercial |
$709.65
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$991.70 |
| Rate for Payer: Aetna of VT Commercial |
$991.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$945.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$945.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$981.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$467.26 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,002.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$945.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$467.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$945.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$635.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$896.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$854.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$474.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$838.73
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$844.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$844.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$844.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$474.75
|
| Rate for Payer: Multiplan Commercial |
$981.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$896.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$474.75
|
| Rate for Payer: United Healthcare Commercial |
$1,002.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.75
|
| Rate for Payer: United Healthcare VA CCN |
$474.75
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$330.85 |
| Max. Negotiated Rate |
$709.65 |
| Rate for Payer: Aetna of VT Commercial |
$709.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$669.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$330.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$669.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$449.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$634.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$605.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$336.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$593.87
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$597.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$597.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.15
|
| Rate for Payer: Multiplan Commercial |
$694.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$634.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$336.15
|
| Rate for Payer: United Healthcare Commercial |
$709.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.15
|
| Rate for Payer: United Healthcare VA CCN |
$336.15
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$353.33 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$780.81 |
| Max. Negotiated Rate |
$1,002.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,002.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$780.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$780.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$896.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$886.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$844.00
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$844.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$844.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$844.00
|
| Rate for Payer: Multiplan Commercial |
$981.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$896.75
|
| Rate for Payer: United Healthcare Commercial |
$1,002.25
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9826902001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.66
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.05
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare VA CCN |
$139.05
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.66
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.05
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare VA CCN |
$139.05
|
|
|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9816902002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$353.33 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
