|
REMOVE EYELID FOREIGN BODY
|
Facility
|
IP
|
$628.98
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$465.51 |
| Max. Negotiated Rate |
$597.53 |
| Rate for Payer: Aetna of VT Commercial |
$597.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$503.18
|
| Rate for Payer: Cash Price |
$314.49
|
| Rate for Payer: Cigna Commercial |
$503.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$503.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$503.18
|
| Rate for Payer: Multiplan Commercial |
$584.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.63
|
| Rate for Payer: United Healthcare Commercial |
$597.53
|
|
|
REMOVE EYELID FOREIGN BODY
|
Facility
|
OP
|
$628.98
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.58 |
| Max. Negotiated Rate |
$597.53 |
| Rate for Payer: Aetna of VT Commercial |
$597.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$509.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$283.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$500.04
|
| Rate for Payer: Cash Price |
$314.49
|
| Rate for Payer: Cigna Commercial |
$503.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$503.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$503.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.04
|
| Rate for Payer: Multiplan Commercial |
$584.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$283.04
|
| Rate for Payer: United Healthcare Commercial |
$597.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.04
|
| Rate for Payer: United Healthcare VA CCN |
$283.04
|
|
|
REMOVE EYELID FOREIGN BODY
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9826793801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$273.10 |
| 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 |
$273.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$273.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$295.20
|
| 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: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.65
|
| Rate for Payer: United Healthcare Commercial |
$350.55
|
|
|
REMOVE EYELID FOREIGN BODY
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9826793801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$109.41 |
| Max. Negotiated Rate |
$469.48 |
| Rate for Payer: Aetna of VT Commercial |
$346.86
|
| 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 |
$112.69
|
| 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 |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$469.48
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$395.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$395.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare Commercial |
$168.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare VA CCN |
$109.41
|
|
|
REMOVE FEMUR LESION
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
9822735501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$579.83 |
| Max. Negotiated Rate |
$2,171.40 |
| Rate for Payer: Aetna of VT Commercial |
$2,171.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,069.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$597.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,069.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$811.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$666.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,028.85
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,093.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$965.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$965.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$579.83
|
| Rate for Payer: Multiplan Commercial |
$2,148.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$823.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$579.83
|
| Rate for Payer: United Healthcare Commercial |
$891.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$579.83
|
| Rate for Payer: United Healthcare VA CCN |
$579.83
|
|
|
REMOVE FEMUR LESION
|
Facility
|
IP
|
$2,310.00
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
9822735501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,709.63 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,709.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,709.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,963.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,940.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,848.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,848.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,848.00
|
| Rate for Payer: Multiplan Commercial |
$2,148.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,963.50
|
| Rate for Payer: United Healthcare Commercial |
$2,194.50
|
|
|
REMOVE FEMUR LESION
|
Facility
|
OP
|
$2,310.00
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
9822735501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,023.10 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: Aetna of VT Commercial |
$2,194.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,069.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,023.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,069.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,390.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,963.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,871.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,039.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,848.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,848.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,848.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,039.50
|
| Rate for Payer: Multiplan Commercial |
$2,148.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,963.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,039.50
|
| Rate for Payer: United Healthcare Commercial |
$2,194.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,039.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,039.50
|
|
|
REMOVE FOREARM FOREIGN BODY
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
9822524801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$1,162.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,162.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,108.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$410.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,108.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$558.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$735.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$735.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$458.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$735.65
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$768.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$663.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$663.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$398.96
|
| Rate for Payer: Multiplan Commercial |
$1,150.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$398.96
|
| Rate for Payer: United Healthcare Commercial |
$613.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.96
|
| Rate for Payer: United Healthcare VA CCN |
$398.96
|
|
|
REMOVE FOREARM FOREIGN BODY
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
9822524801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$547.87 |
| Max. Negotiated Rate |
$1,175.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,175.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,108.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$547.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,108.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$744.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,051.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,001.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$556.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$983.41
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$989.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$989.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$989.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$556.65
|
| Rate for Payer: Multiplan Commercial |
$1,150.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,051.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$556.65
|
| Rate for Payer: United Healthcare Commercial |
$1,175.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.65
|
| Rate for Payer: United Healthcare VA CCN |
$556.65
|
|
|
REMOVE FOREARM FOREIGN BODY
|
Facility
|
IP
|
$1,237.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
9822524801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$915.50 |
| Max. Negotiated Rate |
$1,175.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,175.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$915.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$915.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,051.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,039.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$989.60
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$989.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$989.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$989.60
|
| Rate for Payer: Multiplan Commercial |
$1,150.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,051.45
|
| Rate for Payer: United Healthcare Commercial |
$1,175.15
|
|
|
REMOVE FOREIGN BODY
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
5101012001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$277.30 |
| Rate for Payer: Aetna of VT Commercial |
$277.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.12
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.12
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.76
|
| Rate for Payer: United Healthcare Commercial |
$155.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.76
|
| Rate for Payer: United Healthcare VA CCN |
$100.76
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$5,027.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5101012101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,226.46 |
| Max. Negotiated Rate |
$4,775.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,775.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,503.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,226.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,503.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,026.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,272.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,071.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,262.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,996.47
|
| Rate for Payer: Cash Price |
$2,513.50
|
| Rate for Payer: Cigna Commercial |
$4,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,021.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,262.15
|
| Rate for Payer: Multiplan Commercial |
$4,675.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,272.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,262.15
|
| Rate for Payer: United Healthcare Commercial |
$4,775.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,262.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,262.15
|
|
|
REMOVE FOREIGN BODY
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9811012001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$336.52 |
| Rate for Payer: Aetna of VT Commercial |
$336.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.12
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$234.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$234.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.12
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.76
|
| Rate for Payer: United Healthcare Commercial |
$155.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.76
|
| Rate for Payer: United Healthcare VA CCN |
$100.76
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$294.69
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
4501012001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.10 |
| Max. Negotiated Rate |
$279.96 |
| Rate for Payer: Aetna of VT Commercial |
$279.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.75
|
| Rate for Payer: Cash Price |
$147.34
|
| Rate for Payer: Cigna Commercial |
$235.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.75
|
| Rate for Payer: Multiplan Commercial |
$274.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.49
|
| Rate for Payer: United Healthcare Commercial |
$279.96
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9811012002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.61
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.10
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare VA CCN |
$161.10
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9811012001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.40
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.61
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.10
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare VA CCN |
$161.10
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$5,027.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5101012101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,720.48 |
| Max. Negotiated Rate |
$4,775.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,775.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,720.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,720.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,272.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,222.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,021.60
|
| Rate for Payer: Cash Price |
$2,513.50
|
| Rate for Payer: Cigna Commercial |
$4,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,021.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,021.60
|
| Rate for Payer: Multiplan Commercial |
$4,675.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,272.95
|
| Rate for Payer: United Healthcare Commercial |
$4,775.65
|
|
|
REMOVE FOREIGN BODY
|
Professional
|
Both
|
$5,027.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
5101012101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.89 |
| Max. Negotiated Rate |
$4,725.38 |
| Rate for Payer: Aetna of VT Commercial |
$4,725.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,503.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,503.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$242.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$386.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$198.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.27
|
| Rate for Payer: Cash Price |
$2,513.50
|
| Rate for Payer: Cash Price |
$2,513.50
|
| Rate for Payer: Cigna Commercial |
$316.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$408.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$408.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.98
|
| Rate for Payer: Multiplan Commercial |
$4,675.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$245.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.89
|
| Rate for Payer: United Healthcare Commercial |
$265.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.89
|
| Rate for Payer: United Healthcare VA CCN |
$172.89
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$5,647.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,179.34 |
| Max. Negotiated Rate |
$5,364.65 |
| Rate for Payer: Aetna of VT Commercial |
$5,364.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,179.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,179.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,799.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,743.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,517.60
|
| Rate for Payer: Cash Price |
$2,823.50
|
| Rate for Payer: Cigna Commercial |
$4,517.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,517.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,517.60
|
| Rate for Payer: Multiplan Commercial |
$5,251.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,799.95
|
| Rate for Payer: United Healthcare Commercial |
$5,364.65
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
5101012001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
5101012001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.53
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare VA CCN |
$132.75
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$289.21 |
| Max. Negotiated Rate |
$620.35 |
| Rate for Payer: Aetna of VT Commercial |
$620.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$585.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$289.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$585.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$393.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$555.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$293.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$519.13
|
| Rate for Payer: Cash Price |
$326.50
|
| Rate for Payer: Cigna Commercial |
$522.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$293.85
|
| Rate for Payer: Multiplan Commercial |
$607.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$555.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$293.85
|
| Rate for Payer: United Healthcare Commercial |
$620.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.85
|
| Rate for Payer: United Healthcare VA CCN |
$293.85
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$483.29 |
| Max. Negotiated Rate |
$620.35 |
| Rate for Payer: Aetna of VT Commercial |
$620.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$483.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$555.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$548.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$522.40
|
| Rate for Payer: Cash Price |
$326.50
|
| Rate for Payer: Cigna Commercial |
$522.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$522.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$522.40
|
| Rate for Payer: Multiplan Commercial |
$607.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$555.05
|
| Rate for Payer: United Healthcare Commercial |
$620.35
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$294.69
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
4501012001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.52 |
| Max. Negotiated Rate |
$279.96 |
| Rate for Payer: Aetna of VT Commercial |
$279.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.28
|
| Rate for Payer: Cash Price |
$147.34
|
| Rate for Payer: Cigna Commercial |
$235.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.61
|
| Rate for Payer: Multiplan Commercial |
$274.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.61
|
| Rate for Payer: United Healthcare Commercial |
$279.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.61
|
| Rate for Payer: United Healthcare VA CCN |
$132.61
|
|
