|
RMVL DEVITAL TISS N-SLCTV DBRD
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9609760201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$191.76 |
| Rate for Payer: Aetna of VT Commercial |
$191.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.76
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$99.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.98
|
| Rate for Payer: Multiplan Commercial |
$189.72
|
| Rate for Payer: United Healthcare Commercial |
$173.40
|
| Rate for Payer: United Healthcare VA CCN |
$81.60
|
|
|
RMVL EMBEDDED FB EYELID
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
RMVL EMBEDDED FB EYELID
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$273.10 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna of VT Commercial |
$350.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$273.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$273.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$309.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$295.20
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.20
|
| Rate for Payer: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.65
|
| Rate for Payer: United Healthcare Commercial |
$350.55
|
|
|
RMVL EMBEDDED FB EYELID
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$109.41 |
| Max. Negotiated Rate |
$469.48 |
| Rate for Payer: Aetna of VT Commercial |
$346.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$469.48
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$395.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$395.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare Commercial |
$168.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare VA CCN |
$109.41
|
|
|
RMVL EMBEDDED FB EYELID
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$163.43 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna of VT Commercial |
$350.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$330.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$298.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.36
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.05
|
| Rate for Payer: Multiplan Commercial |
$343.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$313.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.05
|
| Rate for Payer: United Healthcare Commercial |
$350.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.05
|
| Rate for Payer: United Healthcare VA CCN |
$166.05
|
|
|
RMVL EMBEDDED FB EYELID
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$469.48 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$125.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$469.48
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$395.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$395.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$155.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare Commercial |
$168.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.41
|
| Rate for Payer: United Healthcare VA CCN |
$109.41
|
|
|
RMVL EMBEDDED FB EYELID
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
9816793801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$213.92 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna of VT Commercial |
$458.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$213.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$290.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$217.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$383.99
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$217.35
|
| Rate for Payer: Multiplan Commercial |
$449.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$217.35
|
| Rate for Payer: United Healthcare Commercial |
$458.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.35
|
| Rate for Payer: United Healthcare VA CCN |
$217.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.35 |
| Max. Negotiated Rate |
$454.02 |
| Rate for Payer: Aetna of VT Commercial |
$454.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.37
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$187.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$449.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare Commercial |
$177.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare VA CCN |
$115.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.35 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.37
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$187.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare Commercial |
$177.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare VA CCN |
$115.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$320.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.80
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$101.54
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
4503030001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna of VT Commercial |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.23
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cigna Commercial |
$81.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.23
|
| Rate for Payer: Multiplan Commercial |
$94.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.31
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$357.47 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna of VT Commercial |
$458.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$357.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$357.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$410.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$405.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$386.40
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$386.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$449.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$410.55
|
| Rate for Payer: United Healthcare Commercial |
$458.85
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5103030001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$318.87 |
| Rate for Payer: Aetna of VT Commercial |
$95.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.37
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$187.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare Commercial |
$177.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare VA CCN |
$115.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9603030002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.35 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.37
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$187.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare Commercial |
$177.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare VA CCN |
$115.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5103030001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna of VT Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.60
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$101.54
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
4503030001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna of VT Commercial |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.72
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cigna Commercial |
$81.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.69
|
| Rate for Payer: Multiplan Commercial |
$94.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.69
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.69
|
| Rate for Payer: United Healthcare VA CCN |
$45.69
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$115.35 |
| Max. Negotiated Rate |
$358.14 |
| Rate for Payer: Aetna of VT Commercial |
$358.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.37
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$187.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$318.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$318.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare Commercial |
$177.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.35
|
| Rate for Payer: United Healthcare VA CCN |
$115.35
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
5103030001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna of VT Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.09
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.90
|
| Rate for Payer: United Healthcare VA CCN |
$45.90
|
|
|
RMVL FB INTRANASAL OFFICE PROC
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
9813030001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna of VT Commercial |
$361.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$323.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$308.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$302.89
|
| Rate for Payer: Cash Price |
$190.50
|
| Rate for Payer: Cigna Commercial |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$304.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$304.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$354.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$323.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare Commercial |
$361.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: United Healthcare VA CCN |
$171.45
|
|
|
RMVL FB MUSC/TEND SHEATH SMPL
|
Professional
|
Both
|
$2,069.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
5102052001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$1,944.86 |
| Rate for Payer: Aetna of VT Commercial |
$1,944.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,853.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,853.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$378.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$378.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.21
|
| Rate for Payer: Cash Price |
$1,034.50
|
| Rate for Payer: Cash Price |
$1,034.50
|
| Rate for Payer: Cigna Commercial |
$266.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$337.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$337.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$206.68
|
| Rate for Payer: Multiplan Commercial |
$1,924.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.84
|
| Rate for Payer: United Healthcare Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.84
|
| Rate for Payer: United Healthcare VA CCN |
$140.84
|
|
