|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$177.85
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
4506520501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.39
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.03
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.03
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.03
|
| Rate for Payer: United Healthcare VA CCN |
$80.03
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$353.63
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
4506522201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.62 |
| 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 |
$316.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$316.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$212.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$286.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$281.14
|
| 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: Martins Point Health Care Commercial |
$159.13
|
| Rate for Payer: Multiplan Commercial |
$328.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$300.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.13
|
| Rate for Payer: United Healthcare Commercial |
$335.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.13
|
| Rate for Payer: United Healthcare VA CCN |
$159.13
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.95 |
| 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 |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| 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: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520501
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$149.46 |
| Rate for Payer: Aetna of VT Commercial |
$149.46
|
| 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 |
$28.09
|
| 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 |
$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 |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| 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 |
$147.87
|
| 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
|
$186.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9816522002
|
|
Hospital Revenue Code
|
981
|
| 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
|
$258.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9816522201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare VA CCN |
$116.10
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9816520502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$123.14 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare Commercial |
$41.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare VA CCN |
$27.27
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
9606522202
|
|
Hospital Revenue Code
|
960
|
| 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
|
$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
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$228.69 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
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
|
Facility
|
IP
|
$177.85
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
4506520501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna of VT Commercial |
$168.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.28
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna Commercial |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.28
|
| Rate for Payer: Multiplan Commercial |
$165.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.17
|
| Rate for Payer: United Healthcare Commercial |
$168.96
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9816521002
|
|
Hospital Revenue Code
|
981
|
| 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
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$96.95 |
| 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 |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| 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: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$124.45
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,144.93 |
| 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 |
$1,144.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,144.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,314.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,299.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,237.60
|
| 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: Multiplan Commercial |
$1,438.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,314.95
|
| Rate for Payer: United Healthcare Commercial |
$1,469.65
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
9606520502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$123.14 |
| Rate for Payer: Aetna of VT Commercial |
$123.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.95
|
| Rate for Payer: Multiplan Commercial |
$121.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare Commercial |
$41.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.27
|
| Rate for Payer: United Healthcare VA CCN |
$27.27
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
9606522001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$321.20 |
| 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 |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$321.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$368.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.20
|
| 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: Multiplan Commercial |
$403.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$412.30
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
5106520501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$167.32 |
| Rate for Payer: Aetna of VT Commercial |
$167.32
|
| 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 |
$28.09
|
| 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 |
$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 |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| 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 |
$165.54
|
| 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
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$1,454.18 |
| Rate for Payer: Aetna of VT Commercial |
$1,454.18
|
| 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 |
$35.07
|
| 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 |
$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 |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cigna Commercial |
$62.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.30
|
| Rate for Payer: Multiplan Commercial |
$1,438.71
|
| 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
|
$1,711.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
9606521001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$1,608.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,608.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,532.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.44
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$62.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.30
|
| Rate for Payer: Multiplan Commercial |
$1,591.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.05
|
| Rate for Payer: United Healthcare Commercial |
$52.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.05
|
| Rate for Payer: United Healthcare VA CCN |
$34.05
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$248.16
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
4506522001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.66 |
| 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 |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.53
|
| 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: Multiplan Commercial |
$230.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.94
|
| Rate for Payer: United Healthcare Commercial |
$235.75
|
|
|
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
|
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
|
$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
|
|
