|
REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$5,325.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
5102068001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,358.44 |
| 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 |
$4,770.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,358.44
|
| 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 |
$3,205.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,526.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,313.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,396.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,233.38
|
| 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: Martins Point Health Care Commercial |
$2,396.25
|
| Rate for Payer: Multiplan Commercial |
$4,952.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,526.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,396.25
|
| Rate for Payer: United Healthcare Commercial |
$5,058.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,396.25
|
| Rate for Payer: United Healthcare VA CCN |
$2,396.25
|
|
|
REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$6,513.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
9602068001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,820.27 |
| 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 |
$4,820.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,820.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,536.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,470.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,210.40
|
| 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: Multiplan Commercial |
$6,057.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,536.05
|
| Rate for Payer: United Healthcare Commercial |
$6,187.35
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$185.58 |
| Max. Negotiated Rate |
$398.05 |
| Rate for Payer: Aetna of VT Commercial |
$398.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$185.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$252.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$356.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$339.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$333.11
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cigna Commercial |
$335.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$335.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$335.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$188.55
|
| Rate for Payer: Multiplan Commercial |
$389.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$188.55
|
| Rate for Payer: United Healthcare Commercial |
$398.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.55
|
| Rate for Payer: United Healthcare VA CCN |
$188.55
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
OP
|
$194.91
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
4505830101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.33 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.95
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cigna Commercial |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.71
|
| Rate for Payer: Multiplan Commercial |
$181.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.71
|
| Rate for Payer: United Healthcare Commercial |
$185.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.71
|
| Rate for Payer: United Healthcare VA CCN |
$87.71
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830102
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$393.86 |
| Rate for Payer: Aetna of VT Commercial |
$393.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$375.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.12
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cigna Commercial |
$107.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.42
|
| Rate for Payer: Multiplan Commercial |
$389.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare Commercial |
$93.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.66
|
| Rate for Payer: United Healthcare VA CCN |
$60.66
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
IP
|
$194.91
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
4505830101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.93
|
| Rate for Payer: Cash Price |
$97.46
|
| Rate for Payer: Cigna Commercial |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.93
|
| Rate for Payer: Multiplan Commercial |
$181.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.67
|
| Rate for Payer: United Healthcare Commercial |
$185.16
|
|
|
REMOVAL INTRAUTERINE DEVIC IUD
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
9815830101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$398.05 |
| Rate for Payer: Aetna of VT Commercial |
$398.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$310.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$310.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$356.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$335.20
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cigna Commercial |
$335.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$335.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$335.20
|
| Rate for Payer: Multiplan Commercial |
$389.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$356.15
|
| Rate for Payer: United Healthcare Commercial |
$398.05
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna of VT Commercial |
$414.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.67
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$255.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.19
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare VA CCN |
$136.35
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.60
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.45
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare VA CCN |
$198.45
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna of VT Commercial |
$414.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.67
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$255.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.19
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare VA CCN |
$136.35
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.60
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.45
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare VA CCN |
$198.45
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Professional
|
Both
|
$10,874.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5102420001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$10,221.56 |
| Rate for Payer: Aetna of VT Commercial |
$10,221.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,742.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,742.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.67
|
| Rate for Payer: Cash Price |
$5,437.00
|
| Rate for Payer: Cash Price |
$5,437.00
|
| Rate for Payer: Cigna Commercial |
$255.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.19
|
| Rate for Payer: Multiplan Commercial |
$10,112.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare VA CCN |
$136.35
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$195.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$265.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$357.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$350.60
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$198.45
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.45
|
| Rate for Payer: United Healthcare VA CCN |
$198.45
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$10,874.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
5102420001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,816.09 |
| Max. Negotiated Rate |
$10,330.30 |
| Rate for Payer: Aetna of VT Commercial |
$10,330.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,742.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,816.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,742.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6,546.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,242.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,807.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,893.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,644.83
|
| Rate for Payer: Cash Price |
$5,437.00
|
| Rate for Payer: Cigna Commercial |
$8,699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,699.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,893.30
|
| Rate for Payer: Multiplan Commercial |
$10,112.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,242.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,893.30
|
| Rate for Payer: United Healthcare Commercial |
$10,330.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,893.30
|
| Rate for Payer: United Healthcare VA CCN |
$4,893.30
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$11,315.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$8,374.23 |
| Max. Negotiated Rate |
$10,749.25 |
| Rate for Payer: Aetna of VT Commercial |
$10,749.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,374.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,374.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,617.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,504.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9,052.00
|
| Rate for Payer: Cash Price |
$5,657.50
|
| Rate for Payer: Cigna Commercial |
$9,052.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9,052.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9,052.00
|
| Rate for Payer: Multiplan Commercial |
$10,522.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,617.75
|
| Rate for Payer: United Healthcare Commercial |
$10,749.25
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.80
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Professional
|
Both
|
$11,315.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9602420001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$10,636.10 |
| Rate for Payer: Aetna of VT Commercial |
$10,636.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10,137.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10,137.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.67
|
| Rate for Payer: Cash Price |
$5,657.50
|
| Rate for Payer: Cash Price |
$5,657.50
|
| Rate for Payer: Cigna Commercial |
$255.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.19
|
| Rate for Payer: Multiplan Commercial |
$10,522.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare VA CCN |
$136.35
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$10,873.96
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
4502420001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8,047.82 |
| Max. Negotiated Rate |
$10,330.26 |
| Rate for Payer: Aetna of VT Commercial |
$10,330.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,047.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,047.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,242.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9,134.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,699.17
|
| Rate for Payer: Cash Price |
$5,436.98
|
| Rate for Payer: Cigna Commercial |
$8,699.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,699.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,699.17
|
| Rate for Payer: Multiplan Commercial |
$10,112.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,242.87
|
| Rate for Payer: United Healthcare Commercial |
$10,330.26
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$326.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.80
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna of VT Commercial |
$414.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$395.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$190.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.67
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$255.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$345.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$345.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.19
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.35
|
| Rate for Payer: United Healthcare VA CCN |
$136.35
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
9812420001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$326.38 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna of VT Commercial |
$418.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$326.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$352.80
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$352.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$410.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$418.95
|
|
|
REMOVAL OF ARM FOREIGN BODY
|
Facility
|
OP
|
$10,873.96
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
4502420001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,816.08 |
| Max. Negotiated Rate |
$10,330.26 |
| Rate for Payer: Aetna of VT Commercial |
$10,330.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9,741.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,816.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9,741.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6,546.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9,242.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8,807.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,893.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8,644.80
|
| Rate for Payer: Cash Price |
$5,436.98
|
| Rate for Payer: Cigna Commercial |
$8,699.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8,699.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8,699.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,893.28
|
| Rate for Payer: Multiplan Commercial |
$10,112.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,242.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,893.28
|
| Rate for Payer: United Healthcare Commercial |
$10,330.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,893.28
|
| Rate for Payer: United Healthcare VA CCN |
$4,893.28
|
|
