|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$78.84
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
4502055201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.35 |
| Max. Negotiated Rate |
$74.90 |
| Rate for Payer: Aetna of VT Commercial |
$74.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.07
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cigna Commercial |
$63.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.07
|
| Rate for Payer: Multiplan Commercial |
$73.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.01
|
| Rate for Payer: United Healthcare Commercial |
$74.90
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$78.84
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
4502055201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$74.90 |
| Rate for Payer: Aetna of VT Commercial |
$74.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.68
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Cigna Commercial |
$63.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.48
|
| Rate for Payer: Multiplan Commercial |
$73.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.48
|
| Rate for Payer: United Healthcare Commercial |
$74.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.48
|
| Rate for Payer: United Healthcare VA CCN |
$35.48
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
5102055201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna of VT Commercial |
$74.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
5102055201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.20
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9822055201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$166.52 |
| 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 |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.00
|
| 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: Multiplan Commercial |
$209.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$213.75
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9822055201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.07
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.70
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.70
|
| Rate for Payer: United Healthcare VA CCN |
$65.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9602055201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna of VT Commercial |
$211.50
|
| 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 |
$35.10
|
| 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 |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$209.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9822055201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.97
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$52.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare VA CCN |
$34.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
5102055201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna of VT Commercial |
$75.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.80
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$73.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.55
|
| Rate for Payer: United Healthcare VA CCN |
$35.55
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
9812055202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna of VT Commercial |
$138.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.80
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$116.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$124.10
|
| Rate for Payer: United Healthcare Commercial |
$138.70
|
|
|
INJ, VASOPRESSIN, 1 UNIT
|
Facility
|
OP
|
$110.98
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
636J259801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$105.43 |
| Rate for Payer: Aetna of VT Commercial |
$105.43
|
| 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 |
$49.15
|
| 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 |
$66.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.23
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cigna Commercial |
$88.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$103.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.94
|
| Rate for Payer: United Healthcare Commercial |
$105.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.94
|
| Rate for Payer: United Healthcare VA CCN |
$49.94
|
|
|
INJ, VASOPRESSIN, 1 UNIT
|
Facility
|
IP
|
$110.98
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
636J259801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$105.43 |
| Rate for Payer: Aetna of VT Commercial |
$105.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.78
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cigna Commercial |
$88.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.78
|
| Rate for Payer: Multiplan Commercial |
$103.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.33
|
| Rate for Payer: United Healthcare Commercial |
$105.43
|
|
|
INSERT AND REMOVE BONE PIN
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$159.77 |
| Max. Negotiated Rate |
$379.91 |
| Rate for Payer: Aetna of VT Commercial |
$365.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.91
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$300.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.08
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare Commercial |
$245.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare VA CCN |
$159.77
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$287.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$311.20
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
|
|
INSERT AND REMOVE BONE PIN
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9822065001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$159.77 |
| Max. Negotiated Rate |
$379.91 |
| Rate for Payer: Aetna of VT Commercial |
$365.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$164.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$379.91
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$300.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.08
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare Commercial |
$245.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.77
|
| Rate for Payer: United Healthcare VA CCN |
$159.77
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
9812065001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna of VT Commercial |
$369.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$348.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$330.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$309.25
|
| Rate for Payer: Cash Price |
$194.50
|
| Rate for Payer: Cigna Commercial |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$311.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$311.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.05
|
| Rate for Payer: Multiplan Commercial |
$361.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare Commercial |
$369.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.05
|
| Rate for Payer: United Healthcare VA CCN |
$175.05
|
|
