|
NEG PRESS WND TX <=50 SQ CM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9829760701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$513.79 |
| Rate for Payer: Aetna of VT Commercial |
$159.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.49
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$23.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.20
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare Commercial |
$30.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare VA CCN |
$19.56
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
OP
|
$298.83
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
3619760701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$283.89 |
| Rate for Payer: Aetna of VT Commercial |
$283.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$179.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.57
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cigna Commercial |
$239.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$134.47
|
| Rate for Payer: Multiplan Commercial |
$277.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$134.47
|
| Rate for Payer: United Healthcare Commercial |
$283.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.47
|
| Rate for Payer: United Healthcare VA CCN |
$134.47
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.86
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.05
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare VA CCN |
$211.05
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9609760701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$513.79 |
| Rate for Payer: Aetna of VT Commercial |
$440.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.49
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$23.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare Commercial |
$30.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare VA CCN |
$19.56
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
5109760701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.29 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna of VT Commercial |
$284.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.20
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.15
|
| Rate for Payer: United Healthcare Commercial |
$284.05
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
5109760701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$513.79 |
| Rate for Payer: Aetna of VT Commercial |
$281.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.49
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$23.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$320.20
|
| Rate for Payer: Multiplan Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare Commercial |
$30.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare VA CCN |
$19.56
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
IP
|
$298.83
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
3619760701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$283.89 |
| Rate for Payer: Aetna of VT Commercial |
$283.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.06
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cigna Commercial |
$239.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.06
|
| Rate for Payer: Multiplan Commercial |
$277.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.01
|
| Rate for Payer: United Healthcare Commercial |
$283.89
|
|
|
NEG PRESS WND TX <=50 SQ CM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
9829760701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna of VT Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.15
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare Commercial |
$161.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: United Healthcare VA CCN |
$76.50
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$292.34 |
| Rate for Payer: Aetna of VT Commercial |
$292.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.55
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$28.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.73
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare VA CCN |
$23.42
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
5109760501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna of VT Commercial |
$207.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$131.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$185.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$176.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.31
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.10
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.10
|
| Rate for Payer: United Healthcare Commercial |
$207.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.10
|
| Rate for Payer: United Healthcare VA CCN |
$98.10
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9829760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna of VT Commercial |
$87.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.55
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$28.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.73
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare VA CCN |
$23.42
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.80
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
5109760501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna of VT Commercial |
$207.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$185.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.40
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$174.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.30
|
| Rate for Payer: United Healthcare Commercial |
$207.10
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$55.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.94
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.85
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.85
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.85
|
| Rate for Payer: United Healthcare VA CCN |
$41.85
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9829760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.40
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.05
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$68.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.40
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.05
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9829760501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$55.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$41.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.94
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.85
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$41.85
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.85
|
| Rate for Payer: United Healthcare VA CCN |
$41.85
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna of VT Commercial |
$87.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.55
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$28.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.73
|
| Rate for Payer: Multiplan Commercial |
$86.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare VA CCN |
$23.42
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
5109760501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$204.92 |
| Rate for Payer: Aetna of VT Commercial |
$204.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$195.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.55
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$28.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$41.73
|
| Rate for Payer: Multiplan Commercial |
$202.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare Commercial |
$36.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.42
|
| Rate for Payer: United Healthcare VA CCN |
$23.42
|
|
|
NEG PRESS WOUND TX <=50 CM
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
9609760501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna of VT Commercial |
$295.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$264.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.25
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cigna Commercial |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.95
|
| Rate for Payer: Multiplan Commercial |
$289.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare Commercial |
$295.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.95
|
| Rate for Payer: United Healthcare VA CCN |
$139.95
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
5109760801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$665.35 |
| Max. Negotiated Rate |
$854.05 |
| Rate for Payer: Aetna of VT Commercial |
$854.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$665.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$665.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$764.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$755.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$719.20
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$719.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$719.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$719.20
|
| Rate for Payer: Multiplan Commercial |
$836.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$764.15
|
| Rate for Payer: United Healthcare Commercial |
$854.05
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$814.11 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$814.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$924.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$880.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
|
|
NEG PRESS WOUND TX >50 CM
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
5109760801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$845.06 |
| Rate for Payer: Aetna of VT Commercial |
$845.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$805.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$805.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cash Price |
$449.50
|
| Rate for Payer: Cigna Commercial |
$26.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.57
|
| Rate for Payer: Multiplan Commercial |
$836.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare VA CCN |
$22.32
|
|
|
NEG PRESS WOUND TX >50 CM
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9829760801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$535.90 |
| Rate for Payer: Aetna of VT Commercial |
$188.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$180.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$26.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$535.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$535.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.57
|
| Rate for Payer: Multiplan Commercial |
$186.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: United Healthcare VA CCN |
$22.32
|
|
|
NEG PRESS WOUND TX >50 CM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
9609760801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$487.19 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,045.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$985.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$662.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$935.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$891.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$874.50
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$880.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$880.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$495.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$935.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$1,045.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$495.00
|
| Rate for Payer: United Healthcare VA CCN |
$495.00
|
|
