|
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
|
$358.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
9601012002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
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
|
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
|
$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
|
$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
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
9601012102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$275.04 |
| 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 |
$556.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$275.04
|
| 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 |
$373.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$527.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$503.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$279.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$493.69
|
| 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: Martins Point Health Care Commercial |
$279.45
|
| Rate for Payer: Multiplan Commercial |
$577.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$527.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare Commercial |
$589.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.45
|
| Rate for Payer: United Healthcare VA CCN |
$279.45
|
|
|
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
|
$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
|
$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 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
|
$434.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna of VT Commercial |
$412.30
|
| 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 |
$192.22
|
| 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 |
$261.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$351.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$345.03
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna Commercial |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$347.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$195.30
|
| Rate for Payer: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.30
|
| Rate for Payer: United Healthcare VA CCN |
$195.30
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$174.84 |
| Rate for Payer: Aetna of VT Commercial |
$174.84
|
| 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 |
$39.26
|
| 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 |
$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 |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| 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 |
$172.98
|
| 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
|
$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
|
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
|
$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
|
$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
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of VT Commercial |
$124.45
|
| 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 |
$58.02
|
| 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 |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.14
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.95
|
| Rate for Payer: United Healthcare VA CCN |
$58.95
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9606522202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$59.79 |
| 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 |
$120.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.79
|
| 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 |
$81.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$109.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.33
|
| 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: Martins Point Health Care Commercial |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$125.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.75
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.75
|
| Rate for Payer: United Healthcare VA CCN |
$60.75
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
5106520501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.74 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna of VT Commercial |
$169.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.40
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$142.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.40
|
| Rate for Payer: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.30
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
5106522201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.79 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna of VT Commercial |
$336.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$213.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$286.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$281.43
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$283.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$283.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$283.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$159.30
|
| Rate for Payer: Multiplan Commercial |
$329.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.30
|
| Rate for Payer: United Healthcare Commercial |
$336.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.30
|
| Rate for Payer: United Healthcare VA CCN |
$159.30
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$242.52 |
| Rate for Payer: Aetna of VT Commercial |
$242.52
|
| 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 |
$48.52
|
| 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 |
$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 |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| 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 |
$239.94
|
| 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
|
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
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| 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 |
$35.07
|
| 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 |
$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 |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| 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 |
$0.93
|
| 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
|
|
