|
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 S
|
Facility
|
IP
|
$347.42
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
4501602001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.13 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna of VT Commercial |
$330.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$291.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.94
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna Commercial |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.94
|
| Rate for Payer: Multiplan Commercial |
$323.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.31
|
| Rate for Payer: United Healthcare Commercial |
$330.05
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$347.42
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
4501602001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.87 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna of VT Commercial |
$330.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.20
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna Commercial |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.34
|
| Rate for Payer: Multiplan Commercial |
$323.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.34
|
| Rate for Payer: United Healthcare Commercial |
$330.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.34
|
| Rate for Payer: United Healthcare VA CCN |
$156.34
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9821602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$181.42 |
| Rate for Payer: Aetna of VT Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.44
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.85
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare VA CCN |
$86.85
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.40
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.44
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.85
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare VA CCN |
$86.85
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
5101602001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$327.12 |
| Rate for Payer: Aetna of VT Commercial |
$327.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$239.17 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of VT Commercial |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$483.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$239.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$483.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$325.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$429.30
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$432.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$432.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$432.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$243.00
|
| Rate for Payer: Multiplan Commercial |
$502.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.00
|
| Rate for Payer: United Healthcare Commercial |
$513.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.00
|
| Rate for Payer: United Healthcare VA CCN |
$243.00
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9821602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.40
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$507.60 |
| Rate for Payer: Aetna of VT Commercial |
$507.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$483.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$483.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$502.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.40
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9821602001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.44
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.85
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare VA CCN |
$86.85
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
5101602001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.55 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
5101602001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Aetna of VT Commercial |
$330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$311.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.66
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$323.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.60
|
| Rate for Payer: United Healthcare VA CCN |
$156.60
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$116.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$153.44
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$86.85
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.85
|
| Rate for Payer: United Healthcare VA CCN |
$86.85
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$181.42 |
| Rate for Payer: Aetna of VT Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$181.42 |
| Rate for Payer: Aetna of VT Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$399.65 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna of VT Commercial |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$399.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$399.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$432.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$432.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$432.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$502.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.00
|
| Rate for Payer: United Healthcare Commercial |
$513.00
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9811602001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$142.84 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna of VT Commercial |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.40
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$154.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.05
|
| Rate for Payer: United Healthcare Commercial |
$183.35
|
|
|
DRESS/DEBRID P-THICK BURN S
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
9601602002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$181.42 |
| Rate for Payer: Aetna of VT Commercial |
$181.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.92
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$96.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.03
|
| Rate for Payer: Multiplan Commercial |
$179.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare Commercial |
$80.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.45
|
| Rate for Payer: United Healthcare VA CCN |
$52.45
|
|
|
DRESSG ALLDRESS 6X6
|
Facility
|
OP
|
$1.29
|
|
| Hospital Charge Code |
2720031771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of VT Commercial |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.03
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna Commercial |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.58
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.58
|
| Rate for Payer: United Healthcare VA CCN |
$0.58
|
|
|
DRESSG ALLDRESS 6X6
|
Facility
|
IP
|
$1.29
|
|
| Hospital Charge Code |
2720031771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of VT Commercial |
$1.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1.03
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna Commercial |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1.03
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
DRESSG CATHETER IV3000 4X4.75
|
Facility
|
OP
|
$0.66
|
|
| Hospital Charge Code |
2720072021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of VT Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.52
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna Commercial |
$0.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: United Healthcare VA CCN |
$0.30
|
|
|
DRESSG CATHETER IV3000 4X4.75
|
Facility
|
IP
|
$0.66
|
|
| Hospital Charge Code |
2720072021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Aetna of VT Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.53
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna Commercial |
$0.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
|
