|
DRAINAGE SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
9825510001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$201.08 |
| Max. Negotiated Rate |
$431.30 |
| Rate for Payer: Aetna of VT Commercial |
$431.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$406.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$201.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$406.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$273.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$385.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$360.93
|
| Rate for Payer: Cash Price |
$227.00
|
| Rate for Payer: Cigna Commercial |
$363.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.30
|
| Rate for Payer: Multiplan Commercial |
$422.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$385.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$204.30
|
| Rate for Payer: United Healthcare Commercial |
$431.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.30
|
| Rate for Payer: United Healthcare VA CCN |
$204.30
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
|
|
DRAIN BL W/CATH INSERTION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9825110201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$131.38 |
| Max. Negotiated Rate |
$606.30 |
| Rate for Payer: Aetna of VT Commercial |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.37
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$230.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.24
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare Commercial |
$202.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare VA CCN |
$131.38
|
|
|
DRAIN BL W/CATH INSERTION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$131.38 |
| Max. Negotiated Rate |
$606.30 |
| Rate for Payer: Aetna of VT Commercial |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.37
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$230.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.24
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare Commercial |
$202.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare VA CCN |
$131.38
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$5,536.29
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
4505110201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,097.41 |
| Max. Negotiated Rate |
$5,259.48 |
| Rate for Payer: Aetna of VT Commercial |
$5,259.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,097.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,097.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,705.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,650.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,429.03
|
| Rate for Payer: Cash Price |
$2,768.14
|
| Rate for Payer: Cigna Commercial |
$4,429.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,429.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,429.03
|
| Rate for Payer: Multiplan Commercial |
$5,148.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,705.85
|
| Rate for Payer: United Healthcare Commercial |
$5,259.48
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$285.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$388.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.77
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare VA CCN |
$290.25
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9825110201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$285.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$388.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.77
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare VA CCN |
$290.25
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$5,536.29
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
4505110201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,452.02 |
| Max. Negotiated Rate |
$5,259.48 |
| Rate for Payer: Aetna of VT Commercial |
$5,259.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,959.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,452.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,959.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,332.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,705.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,484.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,491.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,401.35
|
| Rate for Payer: Cash Price |
$2,768.14
|
| Rate for Payer: Cigna Commercial |
$4,429.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,429.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,429.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,491.33
|
| Rate for Payer: Multiplan Commercial |
$5,148.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,705.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,491.33
|
| Rate for Payer: United Healthcare Commercial |
$5,259.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,491.33
|
| Rate for Payer: United Healthcare VA CCN |
$2,491.33
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9825110201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$477.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.00
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
|
|
DRAIN BL W/CATH INSERTION
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$131.38 |
| Max. Negotiated Rate |
$606.30 |
| Rate for Payer: Aetna of VT Commercial |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$422.37
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$230.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$363.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$363.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$223.24
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare Commercial |
$202.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.38
|
| Rate for Payer: United Healthcare VA CCN |
$131.38
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
9815110202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna of VT Commercial |
$612.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$285.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$388.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$548.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.77
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$516.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$516.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$599.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$548.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare Commercial |
$612.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.25
|
| Rate for Payer: United Healthcare VA CCN |
$290.25
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$308.32 |
| Rate for Payer: Aetna of VT Commercial |
$308.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.46
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$189.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.59
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$183.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare VA CCN |
$119.02
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$1,587.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
9816900501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$1,174.54 |
| Max. Negotiated Rate |
$1,507.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,507.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,174.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,174.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,348.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,333.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,269.60
|
| Rate for Payer: Cash Price |
$793.50
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,269.60
|
| Rate for Payer: Multiplan Commercial |
$1,475.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.95
|
| Rate for Payer: United Healthcare Commercial |
$1,507.65
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna of VT Commercial |
$413.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$352.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.82
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$348.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$404.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.75
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: United Healthcare VA CCN |
$195.75
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$694.21 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Aetna of VT Commercial |
$891.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$694.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$797.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$787.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.40
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cigna Commercial |
$750.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$750.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$750.40
|
| Rate for Payer: Multiplan Commercial |
$872.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$797.30
|
| Rate for Payer: United Healthcare Commercial |
$891.10
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna of VT Commercial |
$413.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$321.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$369.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$348.00
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$348.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$404.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$369.75
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$1,587.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
9816900501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$702.88 |
| Max. Negotiated Rate |
$1,507.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,507.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,421.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$702.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,421.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$955.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,348.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$714.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,261.66
|
| Rate for Payer: Cash Price |
$793.50
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,269.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,269.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$714.15
|
| Rate for Payer: Multiplan Commercial |
$1,475.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,348.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$714.15
|
| Rate for Payer: United Healthcare Commercial |
$1,507.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.15
|
| Rate for Payer: United Healthcare VA CCN |
$714.15
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
5106900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna of VT Commercial |
$580.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$270.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$519.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$494.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$274.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$485.75
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$488.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$488.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$274.95
|
| Rate for Payer: Multiplan Commercial |
$568.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$519.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$580.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.95
|
| Rate for Payer: United Healthcare VA CCN |
$274.95
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9606900001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$881.72 |
| Rate for Payer: Aetna of VT Commercial |
$881.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$840.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$840.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.46
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cash Price |
$469.00
|
| Rate for Payer: Cigna Commercial |
$189.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.59
|
| Rate for Payer: Multiplan Commercial |
$872.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$183.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare VA CCN |
$119.02
|
|
|
DRAIN EXTERNAL EAR LESION
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$408.90 |
| Rate for Payer: Aetna of VT Commercial |
$408.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$389.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$259.46
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$189.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$284.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$284.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.59
|
| Rate for Payer: Multiplan Commercial |
$404.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$183.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: United Healthcare VA CCN |
$119.02
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
4506900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.16 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$421.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$380.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.65
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.50
|
| Rate for Payer: United Healthcare VA CCN |
$211.50
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna of VT Commercial |
$311.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$293.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.76
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$147.60
|
| Rate for Payer: United Healthcare Commercial |
$311.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.60
|
| Rate for Payer: United Healthcare VA CCN |
$147.60
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
4506900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.85 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna of VT Commercial |
$446.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$399.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.00
|
| Rate for Payer: Multiplan Commercial |
$437.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$399.50
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
|
|
DRAIN EXTERNAL EAR LESION
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
9816900002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$242.75 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna of VT Commercial |
$311.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$262.40
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cigna Commercial |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$262.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$262.40
|
| Rate for Payer: Multiplan Commercial |
$305.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$278.80
|
| Rate for Payer: United Healthcare Commercial |
$311.60
|
|
