|
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
|
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
|
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
|
$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
|
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
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9811012001
|
|
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
|
$5,647.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.89 |
| Max. Negotiated Rate |
$5,308.18 |
| Rate for Payer: Aetna of VT Commercial |
$5,308.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,059.15
|
| 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 |
$5,059.15
|
| 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 |
$2,823.50
|
| Rate for Payer: Cash Price |
$2,823.50
|
| 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 |
$5,251.71
|
| 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
|
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
|
$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
|
$5,647.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,501.06 |
| 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 |
$5,059.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,501.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,059.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,399.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,799.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,574.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,541.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,489.36
|
| 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: Martins Point Health Care Commercial |
$2,541.15
|
| Rate for Payer: Multiplan Commercial |
$5,251.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,799.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,541.15
|
| Rate for Payer: United Healthcare Commercial |
$5,364.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,541.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,541.15
|
|
|
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 FROM EYE
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5106522001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna of VT Commercial |
$236.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.20
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
|
|
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
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$122.12 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna of VT Commercial |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$132.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.00
|
| Rate for Payer: Multiplan Commercial |
$153.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: United Healthcare Commercial |
$156.75
|
|
|
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
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5106522001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$234.06 |
| Rate for Payer: Aetna of VT Commercial |
$234.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.08
|
| 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 |
$223.08
|
| 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 |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| 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 |
$231.57
|
| 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
|
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
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna of VT Commercial |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.70
|
| Rate for Payer: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.70
|
| Rate for Payer: United Healthcare VA CCN |
$83.70
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9606522201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.58 |
| 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 |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$216.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$438.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$294.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$415.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$396.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$220.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.75
|
| 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: Martins Point Health Care Commercial |
$220.05
|
| Rate for Payer: Multiplan Commercial |
$454.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$415.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$220.05
|
| Rate for Payer: United Healthcare Commercial |
$464.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.05
|
| Rate for Payer: United Healthcare VA CCN |
$220.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$136.86 |
| 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 |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.66
|
| 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: Martins Point Health Care Commercial |
$139.05
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare VA CCN |
$139.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna of VT Commercial |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$147.82
|
| 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 |
$147.82
|
| 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 |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| 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 |
$153.45
|
| 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
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$281.06 |
| Rate for Payer: Aetna of VT Commercial |
$281.06
|
| 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 |
$39.26
|
| 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 |
$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 |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| 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 |
$278.07
|
| 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
|
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
|
$135.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9606522202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$168.88 |
| Rate for Payer: Aetna of VT Commercial |
$126.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.88
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$87.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$103.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$103.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.46
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.11
|
| Rate for Payer: United Healthcare Commercial |
$72.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.11
|
| Rate for Payer: United Healthcare VA CCN |
$47.11
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna of VT Commercial |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
|
