|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
5102819201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$3,344.52 |
| Rate for Payer: Aetna of VT Commercial |
$3,344.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$307.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$418.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$612.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$612.07
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$564.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$705.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$705.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$424.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare Commercial |
$459.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.85
|
| Rate for Payer: United Healthcare VA CCN |
$298.85
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9822819201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$716.42 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$813.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$774.40
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$428.73 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$428.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$867.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$582.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$784.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$435.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$769.56
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$435.60
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$435.60
|
| Rate for Payer: United Healthcare VA CCN |
$435.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$4,526.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,349.69 |
| Max. Negotiated Rate |
$4,299.70 |
| Rate for Payer: Aetna of VT Commercial |
$4,299.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,349.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,349.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,847.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,801.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,620.80
|
| Rate for Payer: Cash Price |
$2,263.00
|
| Rate for Payer: Cigna Commercial |
$3,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,620.80
|
| Rate for Payer: Multiplan Commercial |
$4,209.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,847.10
|
| Rate for Payer: United Healthcare Commercial |
$4,299.70
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9812819202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$716.42 |
| Max. Negotiated Rate |
$919.60 |
| Rate for Payer: Aetna of VT Commercial |
$919.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$822.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$813.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$774.40
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cigna Commercial |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$774.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$774.40
|
| Rate for Payer: Multiplan Commercial |
$900.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$822.80
|
| Rate for Payer: United Healthcare Commercial |
$919.60
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
OP
|
$4,526.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
9602819201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,004.57 |
| Max. Negotiated Rate |
$4,299.70 |
| Rate for Payer: Aetna of VT Commercial |
$4,299.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,054.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,004.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,054.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,724.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,847.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,666.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,036.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,598.17
|
| Rate for Payer: Cash Price |
$2,263.00
|
| Rate for Payer: Cigna Commercial |
$3,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,620.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,620.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,036.70
|
| Rate for Payer: Multiplan Commercial |
$4,209.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,847.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,036.70
|
| Rate for Payer: United Healthcare Commercial |
$4,299.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,036.70
|
| Rate for Payer: United Healthcare VA CCN |
$2,036.70
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Facility
|
IP
|
$3,557.48
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
4502819201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,632.89 |
| Max. Negotiated Rate |
$3,379.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,379.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,632.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,632.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,988.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,845.98
|
| Rate for Payer: Cash Price |
$1,778.74
|
| Rate for Payer: Cigna Commercial |
$2,845.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,845.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,845.98
|
| Rate for Payer: Multiplan Commercial |
$3,308.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,023.86
|
| Rate for Payer: United Healthcare Commercial |
$3,379.61
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$456.10
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
4504280901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.01 |
| Max. Negotiated Rate |
$433.30 |
| Rate for Payer: Aetna of VT Commercial |
$433.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$408.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$202.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$408.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$274.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$369.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$205.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$362.60
|
| Rate for Payer: Cash Price |
$228.05
|
| Rate for Payer: Cigna Commercial |
$364.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$205.25
|
| Rate for Payer: Multiplan Commercial |
$424.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$387.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$205.25
|
| Rate for Payer: United Healthcare Commercial |
$433.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$205.25
|
| Rate for Payer: United Healthcare VA CCN |
$205.25
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.66 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna of VT Commercial |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.17
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$190.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$316.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$316.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.82
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare Commercial |
$182.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare VA CCN |
$118.66
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$456.10
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
4504280901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.56 |
| Max. Negotiated Rate |
$433.30 |
| Rate for Payer: Aetna of VT Commercial |
$433.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$337.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$337.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$387.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.88
|
| Rate for Payer: Cash Price |
$228.05
|
| Rate for Payer: Cigna Commercial |
$364.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.88
|
| Rate for Payer: Multiplan Commercial |
$424.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$387.69
|
| Rate for Payer: United Healthcare Commercial |
$433.30
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9824280901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.85
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$118.66 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna of VT Commercial |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.17
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$190.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$316.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$316.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.82
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare Commercial |
$182.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare VA CCN |
$118.66
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9824280901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$318.24 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$318.24 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9824280901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$118.66 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna of VT Commercial |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$166.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.17
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$190.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$316.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$316.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.82
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare Commercial |
$182.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.66
|
| Rate for Payer: United Healthcare VA CCN |
$118.66
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.85
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.85
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
9814280902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$318.24 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
|
|
REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$5,325.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
5102068001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,941.03 |
| Max. Negotiated Rate |
$5,058.75 |
| Rate for Payer: Aetna of VT Commercial |
$5,058.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,941.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,941.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,526.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,473.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,260.00
|
| Rate for Payer: Cash Price |
$2,662.50
|
| Rate for Payer: Cigna Commercial |
$4,260.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,260.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,260.00
|
| Rate for Payer: Multiplan Commercial |
$4,952.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,526.25
|
| Rate for Payer: United Healthcare Commercial |
$5,058.75
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,189.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$396.66 |
| Max. Negotiated Rate |
$1,117.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,117.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$408.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$555.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$731.87
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$751.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.32
|
| Rate for Payer: Multiplan Commercial |
$1,105.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare Commercial |
$610.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare VA CCN |
$396.66
|
|
|
REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$6,513.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,884.61 |
| Max. Negotiated Rate |
$6,187.35 |
| Rate for Payer: Aetna of VT Commercial |
$6,187.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,884.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,920.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,536.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,275.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,930.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,177.84
|
| Rate for Payer: Cash Price |
$3,256.50
|
| Rate for Payer: Cigna Commercial |
$5,210.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,210.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,210.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,930.85
|
| Rate for Payer: Multiplan Commercial |
$6,057.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,536.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,930.85
|
| Rate for Payer: United Healthcare Commercial |
$6,187.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,930.85
|
| Rate for Payer: United Healthcare VA CCN |
$2,930.85
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$6,513.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$396.66 |
| Max. Negotiated Rate |
$6,122.22 |
| Rate for Payer: Aetna of VT Commercial |
$6,122.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$408.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,835.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$555.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$731.87
|
| Rate for Payer: Cash Price |
$3,256.50
|
| Rate for Payer: Cash Price |
$3,256.50
|
| Rate for Payer: Cigna Commercial |
$751.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.32
|
| Rate for Payer: Multiplan Commercial |
$6,057.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare Commercial |
$610.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare VA CCN |
$396.66
|
|
|
REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$879.98 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,129.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$879.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$879.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,010.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$998.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$951.20
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$951.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$951.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$951.20
|
| Rate for Payer: Multiplan Commercial |
$1,105.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare Commercial |
$1,129.55
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$5,325.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
5102068001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.66 |
| Max. Negotiated Rate |
$5,005.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,005.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,770.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$408.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,770.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$555.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$731.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$456.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$731.87
|
| Rate for Payer: Cash Price |
$2,662.50
|
| Rate for Payer: Cash Price |
$2,662.50
|
| Rate for Payer: Cigna Commercial |
$751.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$926.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$926.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$564.32
|
| Rate for Payer: Multiplan Commercial |
$4,952.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$563.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare Commercial |
$610.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.66
|
| Rate for Payer: United Healthcare VA CCN |
$396.66
|
|
|
REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$526.61 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,129.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$526.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$715.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,010.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$963.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$535.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$945.25
|
| Rate for Payer: Cash Price |
$594.50
|
| Rate for Payer: Cigna Commercial |
$951.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$951.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$951.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$535.05
|
| Rate for Payer: Multiplan Commercial |
$1,105.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,010.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$535.05
|
| Rate for Payer: United Healthcare Commercial |
$1,129.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$535.05
|
| Rate for Payer: United Healthcare VA CCN |
$535.05
|
|
