|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
9601100402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,093.87 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,093.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,241.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,182.40
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
OP
|
$1,213.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
5101100401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$537.24 |
| Max. Negotiated Rate |
$1,152.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,152.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,086.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$537.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,086.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$730.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,031.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$982.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$545.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$964.34
|
| Rate for Payer: Cash Price |
$606.50
|
| Rate for Payer: Cigna Commercial |
$970.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$970.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$970.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$545.85
|
| Rate for Payer: Multiplan Commercial |
$1,128.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,031.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$545.85
|
| Rate for Payer: United Healthcare Commercial |
$1,152.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.85
|
| Rate for Payer: United Healthcare VA CCN |
$545.85
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
5101100401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$897.74 |
| Max. Negotiated Rate |
$1,152.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,152.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$897.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$897.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,031.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,018.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$970.40
|
| Rate for Payer: Cash Price |
$606.50
|
| Rate for Payer: Cigna Commercial |
$970.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$970.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$970.40
|
| Rate for Payer: Multiplan Commercial |
$1,128.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,031.05
|
| Rate for Payer: United Healthcare Commercial |
$1,152.35
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Professional
|
Both
|
$2,691.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
9601100401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$513.94 |
| Max. Negotiated Rate |
$2,529.54 |
| Rate for Payer: Aetna of VT Commercial |
$2,529.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,410.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$529.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,410.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$719.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$886.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$886.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$591.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$886.49
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cigna Commercial |
$578.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$869.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$869.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$2,502.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$729.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.94
|
| Rate for Payer: United Healthcare Commercial |
$790.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.94
|
| Rate for Payer: United Healthcare VA CCN |
$513.94
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
9601100402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$513.94 |
| Max. Negotiated Rate |
$1,389.32 |
| Rate for Payer: Aetna of VT Commercial |
$1,389.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$529.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$719.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$886.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$886.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$591.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$886.49
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$578.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$869.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$869.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$513.95
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$729.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$513.94
|
| Rate for Payer: United Healthcare Commercial |
$790.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$513.94
|
| Rate for Payer: United Healthcare VA CCN |
$513.94
|
|
|
DEBRIDE GENITALIA & PERINEUM
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
9601100402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$654.61 |
| Max. Negotiated Rate |
$1,404.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,404.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$654.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,324.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$889.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,256.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,197.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,175.01
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,182.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,182.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$665.10
|
| Rate for Payer: Multiplan Commercial |
$1,374.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,256.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare Commercial |
$1,404.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$665.10
|
| Rate for Payer: United Healthcare VA CCN |
$665.10
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
5101100001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
5101100001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.41 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna of VT Commercial |
$292.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$185.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$244.86
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$292.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.60
|
| Rate for Payer: United Healthcare VA CCN |
$138.60
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
5101100001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.18
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$29.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.05
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare Commercial |
$38.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare VA CCN |
$25.22
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna of VT Commercial |
$289.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.18
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$29.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.05
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare Commercial |
$38.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare VA CCN |
$25.22
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$227.95 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna of VT Commercial |
$292.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.40
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna Commercial |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.40
|
| Rate for Payer: Multiplan Commercial |
$286.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.80
|
| Rate for Payer: United Healthcare Commercial |
$292.60
|
|
|
DEBRIDE INFECTED SKN =<10% BDY
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
9601100002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$124.08 |
| Rate for Payer: Aetna of VT Commercial |
$124.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$25.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.18
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$29.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$90.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$90.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.05
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare Commercial |
$38.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: United Healthcare VA CCN |
$25.22
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9821172001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$92.51 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna of VT Commercial |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.25
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
5101172001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of VT Commercial |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.50
|
| Rate for Payer: United Healthcare Commercial |
$47.50
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
5101172001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$50.92 |
| Rate for Payer: Aetna of VT Commercial |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.92
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$14.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$20.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare VA CCN |
$13.42
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna of VT Commercial |
$117.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.92
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$14.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$20.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare VA CCN |
$13.42
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna of VT Commercial |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.92
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$14.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$20.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare VA CCN |
$13.42
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.62
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.75
|
| Rate for Payer: United Healthcare VA CCN |
$33.75
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.51 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna of VT Commercial |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.25
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna of VT Commercial |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.38
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.25
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.25
|
| Rate for Payer: United Healthcare VA CCN |
$56.25
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9821172001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna of VT Commercial |
$118.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.38
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.25
|
| Rate for Payer: United Healthcare Commercial |
$118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.25
|
| Rate for Payer: United Healthcare VA CCN |
$56.25
|
|
|
DEBRIDE NAIL ANY METHOD 1-5
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9601172002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$55.51 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna of VT Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
|
