|
DEBRID OPEN WOUND 20 SQ CM/<
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
5109759701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$219.02 |
| Rate for Payer: Aetna of VT Commercial |
$219.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$208.74
|
| 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 |
$208.74
|
| 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 |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| 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 |
$216.69
|
| 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
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
5109759701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.20 |
| 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 |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.24
|
| 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: Martins Point Health Care Commercial |
$104.85
|
| Rate for Payer: Multiplan Commercial |
$216.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare Commercial |
$221.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.85
|
| Rate for Payer: United Healthcare VA CCN |
$104.85
|
|
|
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
|
|
|
DEBRID OPEN WOUND 20 SQ CM/<
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9609759702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna of VT Commercial |
$172.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.85
|
| 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 |
$164.85
|
| 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 |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| 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 |
$171.12
|
| 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
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9609759702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.49 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.28
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.80
|
| Rate for Payer: United Healthcare VA CCN |
$82.80
|
|
|
DEBRID OPEN WOUND 20 SQ CM/<
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9609759701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$184.25 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna of VT Commercial |
$395.20
|
| 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 |
$184.25
|
| 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 |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$353.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$330.72
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$332.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$332.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$353.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$187.20
|
| Rate for Payer: United Healthcare Commercial |
$395.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.20
|
| Rate for Payer: United Healthcare VA CCN |
$187.20
|
|
|
DEBRID OPEN WOUND 20 SQ CM/<
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
9609759702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.18 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna of VT Commercial |
$174.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.20
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$171.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.40
|
| Rate for Payer: United Healthcare Commercial |
$174.80
|
|
|
DEB SKIN BONE AT FX SITE
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
9821101201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,203.40 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,544.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,203.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,203.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,382.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,365.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,300.80
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,300.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,300.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,300.80
|
| Rate for Payer: Multiplan Commercial |
$1,512.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare Commercial |
$1,544.70
|
|
|
DEB SKIN BONE AT FX SITE
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
9821101201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$381.97 |
| Max. Negotiated Rate |
$1,528.44 |
| Rate for Payer: Aetna of VT Commercial |
$1,528.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,456.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$393.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,456.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$534.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,180.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,180.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$439.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,180.84
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$429.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$996.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$996.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$603.59
|
| Rate for Payer: Multiplan Commercial |
$1,512.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$542.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$381.97
|
| Rate for Payer: United Healthcare Commercial |
$587.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.97
|
| Rate for Payer: United Healthcare VA CCN |
$381.97
|
|
|
DEB SKIN BONE AT FX SITE
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
9821101201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$720.16 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,544.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,456.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$720.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,456.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$978.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,382.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,317.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$731.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,292.67
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cigna Commercial |
$1,300.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,300.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,300.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$731.70
|
| Rate for Payer: Multiplan Commercial |
$1,512.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,382.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$731.70
|
| Rate for Payer: United Healthcare Commercial |
$1,544.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$731.70
|
| Rate for Payer: United Healthcare VA CCN |
$731.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$185.09
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
4501104201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.98 |
| Max. Negotiated Rate |
$175.84 |
| Rate for Payer: Aetna of VT Commercial |
$175.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.15
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cigna Commercial |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.29
|
| Rate for Payer: Multiplan Commercial |
$172.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.29
|
| Rate for Payer: United Healthcare Commercial |
$175.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.29
|
| Rate for Payer: United Healthcare VA CCN |
$83.29
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9601104202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.20
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$63.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.54
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare Commercial |
$87.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare VA CCN |
$56.69
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9811104202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.20
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$63.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.54
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare Commercial |
$87.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare VA CCN |
$56.69
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
5101104201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.20
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$63.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.54
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare Commercial |
$87.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare VA CCN |
$56.69
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
5101104201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
5101104201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9811104201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9601104202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9811104202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9811104202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9601104201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$348.74 |
| Rate for Payer: Aetna of VT Commercial |
$348.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.20
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$63.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.54
|
| Rate for Payer: Multiplan Commercial |
$345.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare Commercial |
$87.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.69
|
| Rate for Payer: United Healthcare VA CCN |
$56.69
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9811104201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9601104202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
9601104201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$274.58 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna of VT Commercial |
$352.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$315.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.80
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.80
|
| Rate for Payer: Multiplan Commercial |
$345.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.35
|
| Rate for Payer: United Healthcare Commercial |
$352.45
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$185.09
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
4501104201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$175.84 |
| Rate for Payer: Aetna of VT Commercial |
$175.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.07
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cigna Commercial |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.07
|
| Rate for Payer: Multiplan Commercial |
$172.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.33
|
| Rate for Payer: United Healthcare Commercial |
$175.84
|
|
