|
INIT PREVT MED NEW PT 65YR>
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
5109938701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
INIT PREVT MED NEW PT 65YR>
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
5109938701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$275.44 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.44
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$124.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$250.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$250.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare VA CCN |
$120.33
|
|
|
INIT PREVT MED NEW PT 65YR>
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
9609938702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$350.62 |
| Rate for Payer: Aetna of VT Commercial |
$350.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$275.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.44
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$124.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$250.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$250.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$154.85
|
| Rate for Payer: Multiplan Commercial |
$346.89
|
| Rate for Payer: United Healthcare Commercial |
$317.05
|
| Rate for Payer: United Healthcare VA CCN |
$120.33
|
|
|
INJ ARIPIPRAZOLE EXT REL 1MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J0401
|
| Hospital Charge Code |
636J040101
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
INJ ARIPIPRAZOLE EXT REL 1MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J0401
|
| Hospital Charge Code |
636J040101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
INJ ARIPIPRAZOLE EXT REL 1MG
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT J0401
|
| Hospital Charge Code |
636J040101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.03
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.28
|
| Rate for Payer: United Healthcare Commercial |
$11.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.28
|
| Rate for Payer: United Healthcare VA CCN |
$7.28
|
|
|
INJ, BUPIVACAINE LIPOSOME
|
Facility
|
OP
|
$933.53
|
|
|
Service Code
|
HCPCS J0666
|
| Hospital Charge Code |
636J066601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$886.85 |
| Rate for Payer: Aetna of VT Commercial |
$886.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$413.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$561.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$793.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$756.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$420.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$742.16
|
| Rate for Payer: Cash Price |
$466.76
|
| Rate for Payer: Cash Price |
$466.76
|
| Rate for Payer: Cigna Commercial |
$746.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$746.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$746.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$420.09
|
| Rate for Payer: Multiplan Commercial |
$868.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$793.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$420.09
|
| Rate for Payer: United Healthcare Commercial |
$886.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.09
|
| Rate for Payer: United Healthcare VA CCN |
$420.09
|
|
|
INJ, BUPIVACAINE LIPOSOME
|
Facility
|
IP
|
$933.53
|
|
|
Service Code
|
HCPCS J0666
|
| Hospital Charge Code |
636J066601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$690.91 |
| Max. Negotiated Rate |
$886.85 |
| Rate for Payer: Aetna of VT Commercial |
$886.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$690.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$690.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$793.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$746.82
|
| Rate for Payer: Cash Price |
$466.76
|
| Rate for Payer: Cigna Commercial |
$746.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$746.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$746.82
|
| Rate for Payer: Multiplan Commercial |
$868.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$793.50
|
| Rate for Payer: United Healthcare Commercial |
$886.85
|
|
|
INJ, CALCIUM GLUCONATE, NOS
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
NDC 6332336019
|
| Hospital Charge Code |
636J061201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna of VT Commercial |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.63
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cigna Commercial |
$31.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.63
|
| Rate for Payer: Multiplan Commercial |
$36.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.61
|
| Rate for Payer: United Healthcare Commercial |
$37.56
|
|
|
INJ, CALCIUM GLUCONATE, NOS
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
NDC 6332336019
|
| Hospital Charge Code |
636J061201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$37.56 |
| Rate for Payer: Aetna of VT Commercial |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.43
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cigna Commercial |
$31.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$31.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$31.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$36.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$37.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.79
|
| Rate for Payer: United Healthcare VA CCN |
$17.79
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$177.62 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$192.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna of VT Commercial |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$115.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.90
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$94.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare VA CCN |
$61.38
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of VT Commercial |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$215.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.80
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$192.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$192.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.00
|
| Rate for Payer: United Healthcare VA CCN |
$108.00
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.93 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$201.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.53
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$150.30
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare Commercial |
$317.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.30
|
| Rate for Payer: United Healthcare VA CCN |
$150.30
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$313.96 |
| Rate for Payer: Aetna of VT Commercial |
$313.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.92
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$115.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.90
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$94.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare VA CCN |
$61.38
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
9602052701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$247.19 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna of VT Commercial |
$317.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$247.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$247.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.20
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$267.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$267.20
|
| Rate for Payer: Multiplan Commercial |
$310.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$283.90
|
| Rate for Payer: United Healthcare Commercial |
$317.30
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Aetna of VT Commercial |
$90.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$88.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.75
|
| Rate for Payer: United Healthcare Commercial |
$90.25
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$136.81 |
| Rate for Payer: Aetna of VT Commercial |
$89.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.92
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$115.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.90
|
| Rate for Payer: Multiplan Commercial |
$88.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare Commercial |
$94.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.38
|
| Rate for Payer: United Healthcare VA CCN |
$61.38
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
5102052701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$90.25 |
| Rate for Payer: Aetna of VT Commercial |
$90.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$75.53
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$88.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$90.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.75
|
| Rate for Payer: United Healthcare VA CCN |
$42.75
|
|
|
INJECT EPIDURAL BLOOD PATCH
|
Facility
|
IP
|
$883.41
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
7616227301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.81 |
| Max. Negotiated Rate |
$839.24 |
| Rate for Payer: Aetna of VT Commercial |
$839.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$653.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$653.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$742.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$706.73
|
| Rate for Payer: Cash Price |
$441.70
|
| Rate for Payer: Cigna Commercial |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.73
|
| Rate for Payer: Multiplan Commercial |
$821.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$750.90
|
| Rate for Payer: United Healthcare Commercial |
$839.24
|
|
|
INJECT EPIDURAL BLOOD PATCH
|
Facility
|
OP
|
$883.41
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
7616227301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.26 |
| Max. Negotiated Rate |
$839.24 |
| Rate for Payer: Aetna of VT Commercial |
$839.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$391.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$531.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$715.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.31
|
| Rate for Payer: Cash Price |
$441.70
|
| Rate for Payer: Cigna Commercial |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.53
|
| Rate for Payer: Multiplan Commercial |
$821.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$750.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.53
|
| Rate for Payer: United Healthcare Commercial |
$839.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.53
|
| Rate for Payer: United Healthcare VA CCN |
$397.53
|
|
|
INJECT EPIDURAL PATCH
|
Facility
|
OP
|
$883.41
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
4506227301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.26 |
| Max. Negotiated Rate |
$839.24 |
| Rate for Payer: Aetna of VT Commercial |
$839.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$391.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$531.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$715.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$397.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$702.31
|
| Rate for Payer: Cash Price |
$441.70
|
| Rate for Payer: Cigna Commercial |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$706.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$706.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$397.53
|
| Rate for Payer: Multiplan Commercial |
$821.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$750.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$397.53
|
| Rate for Payer: United Healthcare Commercial |
$839.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$397.53
|
| Rate for Payer: United Healthcare VA CCN |
$397.53
|
|
|
INJECT EPIDURAL PATCH
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
9816227302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$658.94 |
| Rate for Payer: Aetna of VT Commercial |
$658.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$233.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$233.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.00
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$147.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.15
|
| Rate for Payer: United Healthcare Commercial |
$163.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.15
|
| Rate for Payer: United Healthcare VA CCN |
$106.15
|
|
|
INJECT EPIDURAL PATCH
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
9816227302
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.47 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna of VT Commercial |
$665.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$310.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$422.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$567.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$315.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$557.29
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$560.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.45
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$595.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$315.45
|
| Rate for Payer: United Healthcare Commercial |
$665.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.45
|
| Rate for Payer: United Healthcare VA CCN |
$315.45
|
|
|
INJECT EPIDURAL PATCH
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
9826227301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$518.81 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna of VT Commercial |
$665.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$518.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$518.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$588.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$560.80
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$560.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$560.80
|
| Rate for Payer: Multiplan Commercial |
$651.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$595.85
|
| Rate for Payer: United Healthcare Commercial |
$665.95
|
|
