|
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
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
9821172001
|
|
Hospital Revenue Code
|
982
|
| 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 6/>
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9821172101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.59
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare VA CCN |
$73.35
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$153.22 |
| Rate for Payer: Aetna of VT Commercial |
$153.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$24.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.87
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare VA CCN |
$22.31
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.40
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9821172101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$120.64 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.40
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
5101172101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.31 |
| 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 |
$22.98
|
| 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 |
$31.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.89
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$24.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.87
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare VA CCN |
$22.31
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9821172101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$153.22 |
| Rate for Payer: Aetna of VT Commercial |
$153.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$24.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.87
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare VA CCN |
$22.31
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
5101172101
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna of VT Commercial |
$83.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.96
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare VA CCN |
$39.60
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
5101172101
|
|
Hospital Revenue Code
|
510
|
| 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 6/>
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna of VT Commercial |
$82.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.89
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$24.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.87
|
| Rate for Payer: Multiplan Commercial |
$81.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$34.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.31
|
| Rate for Payer: United Healthcare VA CCN |
$22.31
|
|
|
DEBRIDE NAIL ANY METHOD 6/>
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
9601172101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna of VT Commercial |
$154.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.59
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$151.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare Commercial |
$154.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.35
|
| Rate for Payer: United Healthcare VA CCN |
$73.35
|
|
|
DEBRIDE SKIN AT FX SITE
|
Professional
|
Both
|
$4,541.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
5101101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.14 |
| Max. Negotiated Rate |
$4,268.54 |
| Rate for Payer: Aetna of VT Commercial |
$4,268.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,068.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,068.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$687.06
|
| Rate for Payer: Cash Price |
$2,270.50
|
| Rate for Payer: Cash Price |
$2,270.50
|
| Rate for Payer: Cigna Commercial |
$288.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$416.13
|
| Rate for Payer: Multiplan Commercial |
$4,223.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare Commercial |
$395.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare VA CCN |
$257.14
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$4,541.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
5101101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,360.79 |
| Max. Negotiated Rate |
$4,313.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,313.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,360.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,360.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,859.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,814.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,632.80
|
| Rate for Payer: Cash Price |
$2,270.50
|
| Rate for Payer: Cigna Commercial |
$3,632.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,632.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,632.80
|
| Rate for Payer: Multiplan Commercial |
$4,223.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,859.85
|
| Rate for Payer: United Healthcare Commercial |
$4,313.95
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$5,756.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,260.02 |
| Max. Negotiated Rate |
$5,468.20 |
| Rate for Payer: Aetna of VT Commercial |
$5,468.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,260.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,260.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,892.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,604.80
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cigna Commercial |
$4,604.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,604.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,604.80
|
| Rate for Payer: Multiplan Commercial |
$5,353.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,892.60
|
| Rate for Payer: United Healthcare Commercial |
$5,468.20
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$5,756.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,549.33 |
| Max. Negotiated Rate |
$5,468.20 |
| Rate for Payer: Aetna of VT Commercial |
$5,468.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,156.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,549.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,156.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,465.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,892.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,662.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,590.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,576.02
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cigna Commercial |
$4,604.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,604.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,604.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,590.20
|
| Rate for Payer: Multiplan Commercial |
$5,353.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,892.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,590.20
|
| Rate for Payer: United Healthcare Commercial |
$5,468.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,590.20
|
| Rate for Payer: United Healthcare VA CCN |
$2,590.20
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$538.12 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,154.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$538.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$731.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,032.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$984.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$546.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$965.92
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$972.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$546.75
|
| Rate for Payer: Multiplan Commercial |
$1,129.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,032.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$546.75
|
| Rate for Payer: United Healthcare Commercial |
$1,154.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$546.75
|
| Rate for Payer: United Healthcare VA CCN |
$546.75
|
|
|
DEBRIDE SKIN AT FX SITE
|
Professional
|
Both
|
$5,756.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$257.14 |
| Max. Negotiated Rate |
$5,410.64 |
| Rate for Payer: Aetna of VT Commercial |
$5,410.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,156.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,156.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$687.06
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cash Price |
$2,878.00
|
| Rate for Payer: Cigna Commercial |
$288.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$416.13
|
| Rate for Payer: Multiplan Commercial |
$5,353.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare Commercial |
$395.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare VA CCN |
$257.14
|
|
|
DEBRIDE SKIN AT FX SITE
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$257.14 |
| Max. Negotiated Rate |
$1,142.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,142.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$264.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,088.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$687.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$295.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$687.06
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$288.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$683.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$683.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$416.13
|
| Rate for Payer: Multiplan Commercial |
$1,129.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare Commercial |
$395.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.14
|
| Rate for Payer: United Healthcare VA CCN |
$257.14
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
9601101002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$899.22 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Aetna of VT Commercial |
$1,154.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$899.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$899.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,032.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,020.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$972.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$972.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$972.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$972.00
|
| Rate for Payer: Multiplan Commercial |
$1,129.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,032.75
|
| Rate for Payer: United Healthcare Commercial |
$1,154.25
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$4,541.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
5101101001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,011.21 |
| Max. Negotiated Rate |
$4,313.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,313.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,068.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,011.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,068.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,733.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,859.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,678.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,043.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,610.09
|
| Rate for Payer: Cash Price |
$2,270.50
|
| Rate for Payer: Cigna Commercial |
$3,632.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,632.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,632.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,043.45
|
| Rate for Payer: Multiplan Commercial |
$4,223.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,859.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,043.45
|
| Rate for Payer: United Healthcare Commercial |
$4,313.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,043.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,043.45
|
|
|
DEBRID OPEN WOUND 20 SQ CM/<
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9609759701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna of VT Commercial |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$372.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.85
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$40.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$153.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$153.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.45
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.13
|
| Rate for Payer: United Healthcare Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.13
|
| Rate for Payer: United Healthcare VA CCN |
$33.13
|
|
|
DEBRID OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
5109759701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna of VT Commercial |
$221.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.40
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$186.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
|
