|
INJ, METHYLPRED SOD SUCC 5MG
|
Facility
|
IP
|
$42.33
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636J291901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$40.21 |
| Rate for Payer: Aetna of VT Commercial |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.86
|
| Rate for Payer: Cash Price |
$21.16
|
| Rate for Payer: Cigna Commercial |
$33.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.98
|
| Rate for Payer: United Healthcare Commercial |
$40.21
|
|
|
INJ, METHYLPRED SOD SUCC 5MG
|
Professional
|
Both
|
$42.33
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
636J291901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$39.79 |
| Rate for Payer: Aetna of VT Commercial |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.24
|
| Rate for Payer: Cash Price |
$21.16
|
| Rate for Payer: Cash Price |
$21.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare VA CCN |
$0.21
|
|
|
INJ MICAFUN NS 150MG/150ML BAG
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS J2246
|
| Hospital Charge Code |
636J224601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.40
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
|
|
INJ MICAFUN NS 150MG/150ML BAG
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS J2246
|
| Hospital Charge Code |
636J224601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.44
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.85
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare VA CCN |
$86.85
|
|
|
INJ OCTAFLUOROPROPANE MIC,ML
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
636Q995601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.17 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$159.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$217.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$287.00
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$162.45
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.45
|
| Rate for Payer: United Healthcare VA CCN |
$162.45
|
|
|
INJ OCTAFLUOROPROPANE MIC,ML
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
636Q995601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.18 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Aetna of VT Commercial |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$303.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.80
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$335.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.85
|
| Rate for Payer: United Healthcare Commercial |
$342.95
|
|
|
INJ PROHANCE MULTIPACK
|
Facility
|
OP
|
$50.38
|
|
|
Service Code
|
HCPCS A9576
|
| Hospital Charge Code |
636A957601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna of VT Commercial |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.05
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cigna Commercial |
$40.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.67
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.67
|
| Rate for Payer: United Healthcare Commercial |
$47.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.67
|
| Rate for Payer: United Healthcare VA CCN |
$22.67
|
|
|
INJ PROHANCE MULTIPACK
|
Facility
|
IP
|
$50.38
|
|
|
Service Code
|
HCPCS A9576
|
| Hospital Charge Code |
636A957601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna of VT Commercial |
$47.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.30
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cigna Commercial |
$40.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.30
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.82
|
| Rate for Payer: United Healthcare Commercial |
$47.86
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$101.42 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.06
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.05
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.05
|
| Rate for Payer: United Healthcare VA CCN |
$103.05
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
5102055101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna of VT Commercial |
$73.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.60
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.45
|
| Rate for Payer: United Healthcare Commercial |
$73.15
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
5102055101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$88.97 |
| Rate for Payer: Aetna of VT Commercial |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.03
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.51
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare Commercial |
$55.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare VA CCN |
$35.88
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$215.26 |
| Rate for Payer: Aetna of VT Commercial |
$215.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$205.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.03
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.51
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare Commercial |
$55.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare VA CCN |
$35.88
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.84
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.40
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.40
|
| Rate for Payer: United Healthcare VA CCN |
$68.40
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
5102055101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna of VT Commercial |
$73.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.22
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$71.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.65
|
| Rate for Payer: United Healthcare Commercial |
$73.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.65
|
| Rate for Payer: United Healthcare VA CCN |
$34.65
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$142.88 |
| Rate for Payer: Aetna of VT Commercial |
$142.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.03
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.51
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare Commercial |
$55.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.88
|
| Rate for Payer: United Healthcare VA CCN |
$35.88
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna of VT Commercial |
$217.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$169.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$194.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.20
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.20
|
| Rate for Payer: Multiplan Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.65
|
| Rate for Payer: United Healthcare Commercial |
$217.55
|
|
|
INJ SGL TENDON OIGIN/INSERTION
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
9602055102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna of VT Commercial |
$144.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.60
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.60
|
| Rate for Payer: Multiplan Commercial |
$141.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.20
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna of VT Commercial |
$146.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.09
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$68.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.85
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare VA CCN |
$36.21
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$128.78 |
| Rate for Payer: Aetna of VT Commercial |
$128.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.09
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$68.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.85
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare VA CCN |
$36.21
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$139.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.02
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.20
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$274.48 |
| Rate for Payer: Aetna of VT Commercial |
$274.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$50.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.09
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$68.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.85
|
| Rate for Payer: Multiplan Commercial |
$271.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.21
|
| Rate for Payer: United Healthcare VA CCN |
$36.21
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna of VT Commercial |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$145.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$148.20
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna of VT Commercial |
$277.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$236.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$131.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$232.14
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$271.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.40
|
| Rate for Payer: United Healthcare Commercial |
$277.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.40
|
| Rate for Payer: United Healthcare VA CCN |
$131.40
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9602055001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.11 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna of VT Commercial |
$277.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$248.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.60
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$233.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$233.60
|
| Rate for Payer: Multiplan Commercial |
$271.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$248.20
|
| Rate for Payer: United Healthcare Commercial |
$277.40
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$136.49
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
4502055001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Aetna of VT Commercial |
$129.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.19
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.19
|
| Rate for Payer: Multiplan Commercial |
$126.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.02
|
| Rate for Payer: United Healthcare Commercial |
$129.67
|
|
