|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$2,261.00
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
9825231801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,673.37 |
| Max. Negotiated Rate |
$2,147.95 |
| Rate for Payer: Aetna of VT Commercial |
$2,147.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,673.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,673.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,921.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,899.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,130.50
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,808.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,808.80
|
| Rate for Payer: Multiplan Commercial |
$2,102.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,921.85
|
| Rate for Payer: United Healthcare Commercial |
$2,147.95
|
|
|
REMOVE BLADDER STONE
|
Professional
|
Both
|
$2,020.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
9825231701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$319.11 |
| Max. Negotiated Rate |
$2,155.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$328.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,809.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$446.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,155.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,155.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$366.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,155.98
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$555.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,305.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,305.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$804.45
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$453.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$319.11
|
| Rate for Payer: United Healthcare Commercial |
$490.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$319.11
|
| Rate for Payer: United Healthcare VA CCN |
$319.11
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
9825231701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,495.00 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,919.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,495.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,696.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,616.00
|
| Rate for Payer: Cash Price |
$1,010.00
|
| Rate for Payer: Cigna Commercial |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,616.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,616.00
|
| Rate for Payer: Multiplan Commercial |
$1,878.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,717.00
|
| Rate for Payer: United Healthcare Commercial |
$1,919.00
|
|
|
REMOVE BONE FIXATION DEVICE
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
9822069401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$896.26 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$896.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,017.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$968.80
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
|
|
REMOVE BONE FIXATION DEVICE
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
9822069401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$327.70 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,138.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$337.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$458.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$653.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$653.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$376.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$653.90
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$618.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$676.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$676.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$411.53
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$465.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$327.70
|
| Rate for Payer: United Healthcare Commercial |
$504.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.70
|
| Rate for Payer: United Healthcare VA CCN |
$327.70
|
|
|
REMOVE BONE FIXATION DEVICE
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
9822069401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,150.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$536.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,084.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$729.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$980.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$544.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$962.75
|
| Rate for Payer: Cash Price |
$605.50
|
| Rate for Payer: Cigna Commercial |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$968.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$968.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$544.95
|
| Rate for Payer: Multiplan Commercial |
$1,126.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,029.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$544.95
|
| Rate for Payer: United Healthcare VA CCN |
$544.95
|
|
|
REMOVE EAR CANAL LESION(S)
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
9826914501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$243.87 |
| Max. Negotiated Rate |
$1,026.48 |
| Rate for Payer: Aetna of VT Commercial |
$1,026.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$978.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$251.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$978.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$510.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$510.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$510.29
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$391.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$625.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$625.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$385.52
|
| Rate for Payer: Multiplan Commercial |
$1,015.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$243.87
|
| Rate for Payer: United Healthcare Commercial |
$375.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.87
|
| Rate for Payer: United Healthcare VA CCN |
$243.87
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
9826914501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$808.19 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,037.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$808.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$808.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$928.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$917.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$873.60
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$873.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$873.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$873.60
|
| Rate for Payer: Multiplan Commercial |
$1,015.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$928.20
|
| Rate for Payer: United Healthcare Commercial |
$1,037.40
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
9826914501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$483.65 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,037.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$978.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$483.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$978.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$657.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$928.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$884.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$868.14
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$873.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$873.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$873.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,015.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$928.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$491.40
|
| Rate for Payer: United Healthcare Commercial |
$1,037.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$491.40
|
| Rate for Payer: United Healthcare VA CCN |
$491.40
|
|
|
REMOVE EPIDIDYMIS LESION
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
9825484001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$725.68 |
| Rate for Payer: Aetna of VT Commercial |
$725.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$691.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$314.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$691.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$427.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$546.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$546.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.18
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$530.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$501.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$501.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$717.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$433.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$305.01
|
| Rate for Payer: United Healthcare Commercial |
$469.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.01
|
| Rate for Payer: United Healthcare VA CCN |
$305.01
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
9825484001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$341.92 |
| Max. Negotiated Rate |
$733.40 |
| Rate for Payer: Aetna of VT Commercial |
$733.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$691.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$341.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$691.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$464.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$625.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$613.74
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$347.40
|
| Rate for Payer: Multiplan Commercial |
$717.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$347.40
|
| Rate for Payer: United Healthcare Commercial |
$733.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.40
|
| Rate for Payer: United Healthcare VA CCN |
$347.40
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
9825484001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$571.36 |
| Max. Negotiated Rate |
$733.40 |
| Rate for Payer: Aetna of VT Commercial |
$733.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$571.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$571.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$656.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$617.60
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$617.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$617.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$617.60
|
| Rate for Payer: Multiplan Commercial |
$717.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$656.20
|
| Rate for Payer: United Healthcare Commercial |
$733.40
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$5,018.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$4,716.92 |
| Rate for Payer: Aetna of VT Commercial |
$4,716.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.09
|
| Rate for Payer: Cash Price |
$2,509.00
|
| Rate for Payer: Cash Price |
$2,509.00
|
| Rate for Payer: Cigna Commercial |
$496.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$442.34
|
| Rate for Payer: Multiplan Commercial |
$4,666.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare Commercial |
$477.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare VA CCN |
$310.32
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$548.75 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$548.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$745.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,003.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$557.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$985.00
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$557.55
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare VA CCN |
$557.55
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$3,779.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
5106911001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,796.84 |
| Max. Negotiated Rate |
$3,590.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,590.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,796.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,796.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,212.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,174.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,023.20
|
| Rate for Payer: Cash Price |
$1,889.50
|
| Rate for Payer: Cigna Commercial |
$3,023.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,023.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,023.20
|
| Rate for Payer: Multiplan Commercial |
$3,514.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,212.15
|
| Rate for Payer: United Healthcare Commercial |
$3,590.05
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
5106911001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$3,552.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,552.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,385.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,385.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.09
|
| Rate for Payer: Cash Price |
$1,889.50
|
| Rate for Payer: Cash Price |
$1,889.50
|
| Rate for Payer: Cigna Commercial |
$496.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$442.34
|
| Rate for Payer: Multiplan Commercial |
$3,514.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare Commercial |
$477.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare VA CCN |
$310.32
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9826911001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$916.98 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,040.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$991.20
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9826911001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$548.75 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$548.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$745.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,003.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$557.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$985.00
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$557.55
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.55
|
| Rate for Payer: United Healthcare VA CCN |
$557.55
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9826911001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$1,164.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,164.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.09
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$496.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$442.34
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare Commercial |
$477.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare VA CCN |
$310.32
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$916.98 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,177.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$916.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,053.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,040.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$991.20
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$991.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,053.15
|
| Rate for Payer: United Healthcare Commercial |
$1,177.05
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$1,164.66 |
| Rate for Payer: Aetna of VT Commercial |
$1,164.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$319.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,110.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$434.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$701.09
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$496.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$720.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$720.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$442.34
|
| Rate for Payer: Multiplan Commercial |
$1,152.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare Commercial |
$477.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.32
|
| Rate for Payer: United Healthcare VA CCN |
$310.32
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$3,779.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
5106911001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,673.72 |
| Max. Negotiated Rate |
$3,590.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,590.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,385.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,673.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,385.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,274.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,212.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,060.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,700.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,004.30
|
| Rate for Payer: Cash Price |
$1,889.50
|
| Rate for Payer: Cigna Commercial |
$3,023.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,023.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,023.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,700.55
|
| Rate for Payer: Multiplan Commercial |
$3,514.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,212.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,700.55
|
| Rate for Payer: United Healthcare Commercial |
$3,590.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,700.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,700.55
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$5,018.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,222.47 |
| Max. Negotiated Rate |
$4,767.10 |
| Rate for Payer: Aetna of VT Commercial |
$4,767.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,495.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,222.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,495.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,020.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,265.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,064.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,258.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,989.31
|
| Rate for Payer: Cash Price |
$2,509.00
|
| Rate for Payer: Cigna Commercial |
$4,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,014.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,258.10
|
| Rate for Payer: Multiplan Commercial |
$4,666.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,265.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,258.10
|
| Rate for Payer: United Healthcare Commercial |
$4,767.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,258.10
|
| Rate for Payer: United Healthcare VA CCN |
$2,258.10
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$5,018.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
9606911001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,713.82 |
| Max. Negotiated Rate |
$4,767.10 |
| Rate for Payer: Aetna of VT Commercial |
$4,767.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,713.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,713.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,265.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,215.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,014.40
|
| Rate for Payer: Cash Price |
$2,509.00
|
| Rate for Payer: Cigna Commercial |
$4,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,014.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,014.40
|
| Rate for Payer: Multiplan Commercial |
$4,666.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,265.30
|
| Rate for Payer: United Healthcare Commercial |
$4,767.10
|
|
|
REMOVE EYELID FOREIGN BODY
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9826793801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$163.43 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna of VT Commercial |
$350.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.36
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.05
|
| Rate for Payer: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.05
|
| Rate for Payer: United Healthcare Commercial |
$350.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.05
|
| Rate for Payer: United Healthcare VA CCN |
$166.05
|
|
