|
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
|
$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
|
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
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.89 |
| Max. Negotiated Rate |
$583.74 |
| Rate for Payer: Aetna of VT Commercial |
$583.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$556.35
|
| 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 |
$556.35
|
| 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 |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| 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 |
$577.53
|
| 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
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012002
|
|
Hospital Revenue Code
|
960
|
| 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
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$613.82 |
| Rate for Payer: Aetna of VT Commercial |
$613.82
|
| 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 |
$103.78
|
| 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 |
$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 |
$326.50
|
| Rate for Payer: Cash Price |
$326.50
|
| 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 |
$607.29
|
| 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
|
$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
|
$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
|
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
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna of VT Commercial |
$589.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$521.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$496.80
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
|
|
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 FROM EYE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare VA CCN |
$116.10
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$221.29 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna of VT Commercial |
$284.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$221.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$239.20
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.15
|
| Rate for Payer: United Healthcare Commercial |
$284.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$123.14 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare Commercial |
$41.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare VA CCN |
$27.27
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$1,546.35
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
4506521001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$684.88 |
| Max. Negotiated Rate |
$1,469.03 |
| Rate for Payer: Aetna of VT Commercial |
$1,469.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,385.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$684.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,385.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$930.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,314.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,252.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$695.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,229.35
|
| Rate for Payer: Cash Price |
$773.18
|
| Rate for Payer: Cigna Commercial |
$1,237.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,237.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,237.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$695.86
|
| Rate for Payer: Multiplan Commercial |
$1,438.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,314.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$695.86
|
| Rate for Payer: United Healthcare Commercial |
$1,469.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.86
|
| Rate for Payer: United Healthcare VA CCN |
$695.86
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$407.96 |
| Rate for Payer: Aetna of VT Commercial |
$407.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$149.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$71.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.07
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.12
|
| Rate for Payer: United Healthcare Commercial |
$58.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.12
|
| Rate for Payer: United Healthcare VA CCN |
$38.12
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$685.17 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,469.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,385.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$685.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,385.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$931.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,314.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,253.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$696.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,229.87
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cigna Commercial |
$1,237.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,237.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,237.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$696.15
|
| Rate for Payer: Multiplan Commercial |
$1,438.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,314.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$696.15
|
| Rate for Payer: United Healthcare Commercial |
$1,469.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$696.15
|
| Rate for Payer: United Healthcare VA CCN |
$696.15
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$190.95 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.40
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.43 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna of VT Commercial |
$284.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$267.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$254.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$242.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.71
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$239.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$239.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$134.55
|
| Rate for Payer: Multiplan Commercial |
$278.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$284.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.55
|
| Rate for Payer: United Healthcare VA CCN |
$134.55
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$1,711.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$1,608.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,608.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.44
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$62.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.30
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.05
|
| Rate for Payer: United Healthcare Commercial |
$52.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.05
|
| Rate for Payer: United Healthcare VA CCN |
$34.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1,546.35
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
4506521001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,144.45 |
| Max. Negotiated Rate |
$1,469.03 |
| Rate for Payer: Aetna of VT Commercial |
$1,469.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,144.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,144.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,314.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,298.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,237.08
|
| Rate for Payer: Cash Price |
$773.18
|
| Rate for Payer: Cigna Commercial |
$1,237.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,237.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,237.08
|
| Rate for Payer: Multiplan Commercial |
$1,438.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,314.40
|
| Rate for Payer: United Healthcare Commercial |
$1,469.03
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9606522201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$361.91 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna of VT Commercial |
$464.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$410.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$391.20
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$391.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$391.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$391.20
|
| Rate for Payer: Multiplan Commercial |
$454.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.65
|
| Rate for Payer: United Healthcare Commercial |
$464.55
|
|
