|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1,711.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,266.31 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,266.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,437.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,368.80
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.66 |
| 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 |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| 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: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
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
|
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
|
OP
|
$248.16
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
4506522001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna of VT Commercial |
$235.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.29
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cigna Commercial |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.67
|
| Rate for Payer: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.67
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.67
|
| Rate for Payer: United Healthcare VA CCN |
$111.67
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$757.80 |
| Max. Negotiated Rate |
$1,625.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,625.45
|
| 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 |
$757.80
|
| 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 |
$1,030.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,454.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,385.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$769.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,360.24
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,368.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,368.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$769.95
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,454.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare Commercial |
$1,625.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$769.95
|
| Rate for Payer: United Healthcare VA CCN |
$769.95
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521002
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
$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
|
IP
|
$353.63
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
4506522201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$335.95 |
| Rate for Payer: Aetna of VT Commercial |
$335.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$297.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.90
|
| Rate for Payer: Cash Price |
$176.82
|
| Rate for Payer: Cigna Commercial |
$282.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.90
|
| Rate for Payer: Multiplan Commercial |
$328.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.59
|
| Rate for Payer: United Healthcare Commercial |
$335.95
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521002
|
|
Hospital Revenue Code
|
960
|
| 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
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$73.08 |
| 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 |
$147.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.08
|
| 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 |
$99.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.18
|
| 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: Martins Point Health Care Commercial |
$74.25
|
| Rate for Payer: Multiplan Commercial |
$153.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$156.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.25
|
| Rate for Payer: United Healthcare VA CCN |
$74.25
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
5106522201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$332.76 |
| Rate for Payer: Aetna of VT Commercial |
$332.76
|
| 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 |
$48.52
|
| 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 |
$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 |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| 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 |
$329.22
|
| 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
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520502
|
|
Hospital Revenue Code
|
981
|
| 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
|
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
|
$309.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$290.46 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| 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 |
$28.09
|
| 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 |
$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 |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| 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 |
$287.37
|
| 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
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5106522001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.28 |
| 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 |
$223.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.28
|
| 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 |
$149.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.96
|
| 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: Martins Point Health Care Commercial |
$112.05
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare VA CCN |
$112.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna of VT Commercial |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$142.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.41
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.55
|
| Rate for Payer: Multiplan Commercial |
$147.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.55
|
| Rate for Payer: United Healthcare VA CCN |
$71.55
|
|
|
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
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$137.66 |
| 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 |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$156.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.80
|
| 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: Multiplan Commercial |
$172.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.10
|
| Rate for Payer: United Healthcare Commercial |
$176.70
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
5106520501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.84 |
| 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 |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.51
|
| 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: Martins Point Health Care Commercial |
$80.10
|
| Rate for Payer: Multiplan Commercial |
$165.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.10
|
| Rate for Payer: United Healthcare Commercial |
$169.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.10
|
| Rate for Payer: United Healthcare VA CCN |
$80.10
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522202
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
