|
DRAIN OUTER EAR CANAL LESION
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
9606902002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$353.33 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$157.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$319.77
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$218.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$353.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$353.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.78
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$194.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.84
|
| Rate for Payer: United Healthcare VA CCN |
$136.84
|
|
|
DRAIN THIGH/KNEE LESION
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
9822730101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$751.60 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$751.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,021.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,442.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$763.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,349.12
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,357.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$763.65
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,442.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$763.65
|
| Rate for Payer: United Healthcare Commercial |
$1,612.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$763.65
|
| Rate for Payer: United Healthcare VA CCN |
$763.65
|
|
|
DRAIN THIGH/KNEE LESION
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
9822730101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$481.28 |
| Max. Negotiated Rate |
$1,595.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,595.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$495.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,520.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$673.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,065.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,065.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$553.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,065.63
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$911.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,049.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,049.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$634.81
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$683.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$481.28
|
| Rate for Payer: United Healthcare Commercial |
$740.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$481.28
|
| Rate for Payer: United Healthcare VA CCN |
$481.28
|
|
|
DRAIN THIGH/KNEE LESION
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
9822730101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,255.95 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,612.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,255.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,255.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,442.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,425.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,357.60
|
| Rate for Payer: Cash Price |
$848.50
|
| Rate for Payer: Cigna Commercial |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,357.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,357.60
|
| Rate for Payer: Multiplan Commercial |
$1,578.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,442.45
|
| Rate for Payer: United Healthcare Commercial |
$1,612.15
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$595.96 |
| Rate for Payer: Aetna of VT Commercial |
$595.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.53
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$222.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$308.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$308.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.65
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare Commercial |
$187.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare VA CCN |
$121.73
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$469.22 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$507.20
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$595.96 |
| Rate for Payer: Aetna of VT Commercial |
$595.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.53
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$222.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$308.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$308.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.65
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare Commercial |
$187.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare VA CCN |
$121.73
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9821603001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$469.22 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$507.20
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$469.22 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$469.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$507.20
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9821603001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$381.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$285.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.03
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.30
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare VA CCN |
$285.30
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
OP
|
$511.83
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
4501603001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.69 |
| Max. Negotiated Rate |
$486.24 |
| Rate for Payer: Aetna of VT Commercial |
$486.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$458.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$226.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$458.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$230.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$406.90
|
| Rate for Payer: Cash Price |
$255.92
|
| Rate for Payer: Cigna Commercial |
$409.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$409.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$409.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$230.32
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$230.32
|
| Rate for Payer: United Healthcare Commercial |
$486.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.32
|
| Rate for Payer: United Healthcare VA CCN |
$230.32
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
IP
|
$511.83
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
4501603001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.81 |
| Max. Negotiated Rate |
$486.24 |
| Rate for Payer: Aetna of VT Commercial |
$486.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$429.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$409.46
|
| Rate for Payer: Cash Price |
$255.92
|
| Rate for Payer: Cigna Commercial |
$409.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$409.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$409.46
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.06
|
| Rate for Payer: United Healthcare Commercial |
$486.24
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$381.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$285.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.03
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.30
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare VA CCN |
$285.30
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9821603001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$595.96 |
| Rate for Payer: Aetna of VT Commercial |
$595.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$283.53
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$222.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$308.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$308.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.65
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare Commercial |
$187.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.73
|
| Rate for Payer: United Healthcare VA CCN |
$121.73
|
|
|
DRESS/DEBRID P-THICK BURN L
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
9811603002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$602.30 |
| Rate for Payer: Aetna of VT Commercial |
$602.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$568.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$381.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$538.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$513.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$285.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$504.03
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$507.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$507.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.30
|
| Rate for Payer: Multiplan Commercial |
$589.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$538.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare Commercial |
$602.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.30
|
| Rate for Payer: United Healthcare VA CCN |
$285.30
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
OP
|
$288.98
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
4501602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.99 |
| Max. Negotiated Rate |
$274.53 |
| Rate for Payer: Aetna of VT Commercial |
$274.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$258.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$258.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.74
|
| Rate for Payer: Cash Price |
$144.49
|
| Rate for Payer: Cigna Commercial |
$231.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.04
|
| Rate for Payer: Multiplan Commercial |
$268.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.04
|
| Rate for Payer: United Healthcare Commercial |
$274.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.04
|
| Rate for Payer: United Healthcare VA CCN |
$130.04
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9821602501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.38
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare VA CCN |
$146.25
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9811602501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9811602502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna of VT Commercial |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$190.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$241.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$241.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.22
|
| Rate for Payer: United Healthcare Commercial |
$158.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.22
|
| Rate for Payer: United Healthcare VA CCN |
$103.22
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9811602501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.38
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare VA CCN |
$146.25
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9811602502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
IP
|
$288.98
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
4501602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.87 |
| Max. Negotiated Rate |
$274.53 |
| Rate for Payer: Aetna of VT Commercial |
$274.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$213.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$213.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.18
|
| Rate for Payer: Cash Price |
$144.49
|
| Rate for Payer: Cigna Commercial |
$231.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.18
|
| Rate for Payer: Multiplan Commercial |
$268.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.63
|
| Rate for Payer: United Healthcare Commercial |
$274.53
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9811602502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$263.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.38
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.25
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.25
|
| Rate for Payer: United Healthcare VA CCN |
$146.25
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9821602501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna of VT Commercial |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.49
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$190.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$241.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$241.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$146.90
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.22
|
| Rate for Payer: United Healthcare Commercial |
$158.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.22
|
| Rate for Payer: United Healthcare VA CCN |
$103.22
|
|
|
DRESS/DEBRID P-THICK BURN M
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
9821602501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna of VT Commercial |
$308.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$276.25
|
| Rate for Payer: United Healthcare Commercial |
$308.75
|
|
