|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920902
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
$106.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9816921002
|
|
Hospital Revenue Code
|
981
|
| 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
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5106920901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna of VT Commercial |
$112.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$87.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$87.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.40
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$94.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$109.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.30
|
| Rate for Payer: United Healthcare Commercial |
$112.10
|
|
|
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
|
|
|
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
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9816921001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Aetna of VT Commercial |
$152.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$119.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$119.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.80
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$149.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$152.95
|
|
|
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
|
$208.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9606921001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$195.52 |
| Rate for Payer: Aetna of VT Commercial |
$195.52
|
| 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 |
$30.80
|
| 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 |
$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 |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| 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 |
$193.44
|
| 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
|
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
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9606920902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.75 |
| 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 |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.80
|
| 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: Multiplan Commercial |
$47.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.35
|
| Rate for Payer: United Healthcare Commercial |
$48.45
|
|
|
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
|
$118.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5106920901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna of VT Commercial |
$112.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$100.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$95.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.81
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$94.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$94.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$94.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.10
|
| Rate for Payer: Multiplan Commercial |
$109.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.10
|
| Rate for Payer: United Healthcare Commercial |
$112.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.10
|
| Rate for Payer: United Healthcare VA CCN |
$53.10
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5106920901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$110.92 |
| Rate for Payer: Aetna of VT Commercial |
$110.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.72
|
| 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 |
$105.72
|
| 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 |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| 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 |
$109.74
|
| 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
|
$27.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
9816920901
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna of VT Commercial |
$25.38
|
| 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 |
$15.39
|
| 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 |
$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 |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| 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 |
$25.11
|
| 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
|
$161.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9816921001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$151.34 |
| Rate for Payer: Aetna of VT Commercial |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.24
|
| 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 |
$144.24
|
| 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 |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| 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 |
$149.73
|
| 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
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
9816921002
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
5106921001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna of VT Commercial |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.89
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.35
|
| Rate for Payer: Multiplan Commercial |
$95.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare Commercial |
$97.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.35
|
| Rate for Payer: United Healthcare VA CCN |
$46.35
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
IP
|
$117.23
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4506920901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.76 |
| 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 |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.78
|
| 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: Multiplan Commercial |
$109.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.65
|
| Rate for Payer: United Healthcare Commercial |
$111.37
|
|
|
REMOVE IN/EX HEM GROUPS 2+
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
9824626001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$891.82 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,144.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$891.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$891.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,024.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,012.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$964.00
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$964.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$964.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$964.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,024.25
|
| Rate for Payer: United Healthcare Commercial |
$1,144.75
|
|
|
REMOVE IN/EX HEM GROUPS 2+
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
9824626001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$453.07 |
| Max. Negotiated Rate |
$1,132.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,132.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,079.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$466.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,079.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$634.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$683.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$683.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$521.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.95
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$826.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$755.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$755.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$453.08
|
| Rate for Payer: Multiplan Commercial |
$1,120.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$643.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$453.07
|
| Rate for Payer: United Healthcare Commercial |
$696.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$453.07
|
| Rate for Payer: United Healthcare VA CCN |
$453.07
|
|
|
REMOVE IN/EX HEM GROUPS 2+
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
9824626001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$533.69 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,144.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,079.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$533.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,079.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$725.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,024.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$976.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$542.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$957.98
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$964.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$964.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$964.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$542.25
|
| Rate for Payer: Multiplan Commercial |
$1,120.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,024.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$542.25
|
| Rate for Payer: United Healthcare Commercial |
$1,144.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$542.25
|
| Rate for Payer: United Healthcare VA CCN |
$542.25
|
|
|
REMOVE INT/EXT HEM 1 GROUP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
9824625501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$1,019.90 |
| Rate for Payer: Aetna of VT Commercial |
$1,019.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$344.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$972.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$467.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$710.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$710.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$384.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$710.66
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$609.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$805.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$805.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$490.92
|
| Rate for Payer: Multiplan Commercial |
$1,009.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$474.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$334.18
|
| Rate for Payer: United Healthcare Commercial |
$514.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.18
|
| Rate for Payer: United Healthcare VA CCN |
$334.18
|
|
