|
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
|
$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
|
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
|
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/GRAFT LEG BONE LESION
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT 27637
|
| Hospital Charge Code |
9822763701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,190.96 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,554.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,190.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,618.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,285.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,178.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,210.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,137.76
|
| Rate for Payer: Cash Price |
$1,344.50
|
| Rate for Payer: Cigna Commercial |
$2,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,151.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,210.05
|
| Rate for Payer: Multiplan Commercial |
$2,500.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,285.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,210.05
|
| Rate for Payer: United Healthcare Commercial |
$2,554.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,210.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,210.05
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Professional
|
Both
|
$2,689.00
|
|
|
Service Code
|
CPT 27637
|
| Hospital Charge Code |
9822763701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$709.70 |
| Max. Negotiated Rate |
$2,527.66 |
| Rate for Payer: Aetna of VT Commercial |
$2,527.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$730.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,409.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$993.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,349.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,349.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$816.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,349.66
|
| Rate for Payer: Cash Price |
$1,344.50
|
| Rate for Payer: Cash Price |
$1,344.50
|
| Rate for Payer: Cigna Commercial |
$1,339.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,180.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,180.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$709.70
|
| Rate for Payer: Multiplan Commercial |
$2,500.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,007.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$709.70
|
| Rate for Payer: United Healthcare Commercial |
$1,091.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$709.70
|
| Rate for Payer: United Healthcare VA CCN |
$709.70
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT 27637
|
| Hospital Charge Code |
9822763701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,990.13 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Aetna of VT Commercial |
$2,554.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,990.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,990.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,285.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,258.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,151.20
|
| Rate for Payer: Cash Price |
$1,344.50
|
| Rate for Payer: Cigna Commercial |
$2,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,151.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,151.20
|
| Rate for Payer: Multiplan Commercial |
$2,500.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare Commercial |
$2,554.55
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
IP
|
$4,720.99
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
4502708601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,494.00 |
| Max. Negotiated Rate |
$4,484.94 |
| Rate for Payer: Aetna of VT Commercial |
$4,484.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,494.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,012.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,965.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,776.79
|
| Rate for Payer: Cash Price |
$2,360.50
|
| Rate for Payer: Cigna Commercial |
$3,776.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,776.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,776.79
|
| Rate for Payer: Multiplan Commercial |
$4,390.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,012.84
|
| Rate for Payer: United Healthcare Commercial |
$4,484.94
|
|
|
REMOVE HIP FOREIGN BODY
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
9812708602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.15 |
| Max. Negotiated Rate |
$479.85 |
| Rate for Payer: Aetna of VT Commercial |
$246.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$165.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$462.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$462.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$462.31
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$305.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$479.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$479.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$294.12
|
| Rate for Payer: Multiplan Commercial |
$243.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.15
|
| Rate for Payer: United Healthcare Commercial |
$247.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.15
|
| Rate for Payer: United Healthcare VA CCN |
$161.15
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
9812708602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.04 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna of VT Commercial |
$248.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$234.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$116.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$234.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$212.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.29
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$209.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.90
|
| Rate for Payer: Multiplan Commercial |
$243.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.90
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.90
|
| Rate for Payer: United Healthcare VA CCN |
$117.90
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
9812708602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$193.91 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna of VT Commercial |
$248.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$222.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$209.60
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$209.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$209.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$243.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.70
|
| Rate for Payer: United Healthcare Commercial |
$248.90
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
OP
|
$4,720.99
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
4502708601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,090.93 |
| Max. Negotiated Rate |
$4,484.94 |
| Rate for Payer: Aetna of VT Commercial |
$4,484.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,229.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,090.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,229.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,842.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,012.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,824.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,124.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,753.19
|
| Rate for Payer: Cash Price |
$2,360.50
|
| Rate for Payer: Cigna Commercial |
$3,776.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,776.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,776.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,124.45
|
| Rate for Payer: Multiplan Commercial |
$4,390.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,012.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,124.45
|
| Rate for Payer: United Healthcare Commercial |
$4,484.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,124.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,124.45
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare VA CCN |
$75.60
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9816920901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna of VT Commercial |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.46
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$25.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare VA CCN |
$12.15
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9816920902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna of VT Commercial |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.88
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$24.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.94
|
| Rate for Payer: Multiplan Commercial |
$47.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare VA CCN |
$14.94
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Aetna of VT Commercial |
$157.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.88
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$24.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.94
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare VA CCN |
$14.94
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9606921001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of VT Commercial |
$197.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$186.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.36
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$193.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.60
|
| Rate for Payer: United Healthcare Commercial |
$197.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.60
|
| Rate for Payer: United Healthcare VA CCN |
$93.60
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9606921002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$99.64 |
| Rate for Payer: Aetna of VT Commercial |
$99.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.40
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$48.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.32
|
| Rate for Payer: Multiplan Commercial |
$98.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.90
|
| Rate for Payer: United Healthcare Commercial |
$46.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.90
|
| Rate for Payer: United Healthcare VA CCN |
$29.90
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9816920902
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna of VT Commercial |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.55
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$40.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.95
|
| Rate for Payer: Multiplan Commercial |
$47.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$48.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.95
|
| Rate for Payer: United Healthcare VA CCN |
$22.95
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9606921002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna of VT Commercial |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.27
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$84.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$98.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.70
|
| Rate for Payer: United Healthcare Commercial |
$100.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.70
|
| Rate for Payer: United Healthcare VA CCN |
$47.70
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna of VT Commercial |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.88
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$24.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.94
|
| Rate for Payer: Multiplan Commercial |
$47.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.94
|
| Rate for Payer: United Healthcare VA CCN |
$14.94
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$117.23
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4506920901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$111.37 |
| Rate for Payer: Aetna of VT Commercial |
$111.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.20
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$93.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$109.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.75
|
| Rate for Payer: United Healthcare Commercial |
$111.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.75
|
| Rate for Payer: United Healthcare VA CCN |
$52.75
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$102.37
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
4506921001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.34 |
| Max. Negotiated Rate |
$97.25 |
| Rate for Payer: Aetna of VT Commercial |
$97.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.38
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cigna Commercial |
$81.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.07
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.07
|
| Rate for Payer: United Healthcare Commercial |
$97.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.07
|
| Rate for Payer: United Healthcare VA CCN |
$46.07
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9606921002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$78.45 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna of VT Commercial |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.80
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$84.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$98.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.10
|
| Rate for Payer: United Healthcare Commercial |
$100.70
|
|
