|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9812055002
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
$137.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.68 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna of VT Commercial |
$130.15
|
| 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 |
$60.68
|
| 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 |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.92
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.65
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.65
|
| Rate for Payer: United Healthcare Commercial |
$130.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.65
|
| Rate for Payer: United Healthcare VA CCN |
$61.65
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
5102055001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna of VT Commercial |
$130.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$116.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.60
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$109.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$109.60
|
| Rate for Payer: Multiplan Commercial |
$127.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$116.45
|
| Rate for Payer: United Healthcare Commercial |
$130.15
|
|
|
INJ TENDON SHEATH/LIGAMENT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9812055001
|
|
Hospital Revenue Code
|
981
|
| 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
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9822055001
|
|
Hospital Revenue Code
|
982
|
| 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
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9822055001
|
|
Hospital Revenue Code
|
982
|
| 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
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9812055001
|
|
Hospital Revenue Code
|
981
|
| 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
|
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 |
9812055002
|
|
Hospital Revenue Code
|
981
|
| 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
|
$156.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
9812055002
|
|
Hospital Revenue Code
|
981
|
| 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
|
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 TESTOSTERONE CYPIONATE
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
636J107103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.03
|
|
|
INJ TESTOSTERONE CYPIONATE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
636J107103
|
|
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 TESTOSTERONE CYPIONATE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
636J107103
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.08
|
| 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 |
$0.08
|
| 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 THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$174.84 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.97
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$99.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare Commercial |
$81.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare VA CCN |
$52.68
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| 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 THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$340.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| 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 THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Aetna of VT Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.97
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$99.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare Commercial |
$81.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare VA CCN |
$52.68
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052601
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$188.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna of VT Commercial |
$403.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$188.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$380.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$361.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$337.88
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$340.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$340.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$361.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.25
|
| Rate for Payer: United Healthcare VA CCN |
$191.25
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
5102052601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.68 |
| 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 |
$54.26
|
| 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 |
$73.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.97
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$99.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare Commercial |
$81.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.68
|
| Rate for Payer: United Healthcare VA CCN |
$52.68
|
|
|
INJ THERAPEUTIC CARPAL TUNNEL
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
9602052602
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna of VT Commercial |
$213.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.88
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$180.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$209.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$213.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.25
|
| Rate for Payer: United Healthcare VA CCN |
$101.25
|
|
