|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
5101198201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
9601198201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$228.54 |
| Max. Negotiated Rate |
$490.20 |
| Rate for Payer: Aetna of VT Commercial |
$490.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$228.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$310.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$417.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.22
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$412.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$412.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$412.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$479.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$232.20
|
| Rate for Payer: United Healthcare Commercial |
$490.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.20
|
| Rate for Payer: United Healthcare VA CCN |
$232.20
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
9601198202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.37 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna of VT Commercial |
$323.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$286.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$272.80
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$272.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.80
|
| Rate for Payer: Multiplan Commercial |
$317.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.85
|
| Rate for Payer: United Healthcare Commercial |
$323.95
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
9601198201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna of VT Commercial |
$485.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$462.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$462.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.97
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$122.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$479.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.79
|
| Rate for Payer: United Healthcare Commercial |
$102.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.79
|
| Rate for Payer: United Healthcare VA CCN |
$66.79
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
9601198202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna of VT Commercial |
$320.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$230.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.97
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$122.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.09
|
| Rate for Payer: Multiplan Commercial |
$317.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.79
|
| Rate for Payer: United Healthcare Commercial |
$102.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.79
|
| Rate for Payer: United Healthcare VA CCN |
$66.79
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
9601198202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$151.03 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna of VT Commercial |
$323.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$305.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$205.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$289.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$153.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$271.10
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$272.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$272.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$272.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$153.45
|
| Rate for Payer: Multiplan Commercial |
$317.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$289.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$153.45
|
| Rate for Payer: United Healthcare Commercial |
$323.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.45
|
| Rate for Payer: United Healthcare VA CCN |
$153.45
|
|
|
RMVL NON-BIOD DRUG DLVR IMPLT
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
5101198201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9822819001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$369.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.33
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$275.85
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare VA CCN |
$275.85
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
5102819001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$354.32 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$636.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.00
|
| Rate for Payer: United Healthcare VA CCN |
$360.00
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9822819001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$576.22 |
| Rate for Payer: Aetna of VT Commercial |
$576.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$576.22 |
| Rate for Payer: Aetna of VT Commercial |
$576.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$453.68 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.40
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819001
|
|
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 OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819001
|
|
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 OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$369.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.33
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$275.85
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare VA CCN |
$275.85
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$453.68 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$453.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$514.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.40
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$625.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$850.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,200.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,143.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$635.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,122.54
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,129.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$635.40
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,200.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$635.40
|
| Rate for Payer: United Healthcare Commercial |
$1,341.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$635.40
|
| Rate for Payer: United Healthcare VA CCN |
$635.40
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$1,327.28 |
| Rate for Payer: Aetna of VT Commercial |
$1,327.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,265.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$576.22 |
| Rate for Payer: Aetna of VT Commercial |
$576.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
5102819001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$592.08 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna of VT Commercial |
$760.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$680.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$640.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$640.00
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$760.00
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$799.71
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
4502819001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.19 |
| Max. Negotiated Rate |
$759.72 |
| Rate for Payer: Aetna of VT Commercial |
$759.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$354.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$481.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$647.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$359.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$635.77
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cigna Commercial |
$639.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$639.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$639.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$359.87
|
| Rate for Payer: Multiplan Commercial |
$743.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$679.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$359.87
|
| Rate for Payer: United Healthcare Commercial |
$759.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.87
|
| Rate for Payer: United Healthcare VA CCN |
$359.87
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$799.71
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
4502819001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.87 |
| Max. Negotiated Rate |
$759.72 |
| Rate for Payer: Aetna of VT Commercial |
$759.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$591.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$591.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$671.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$639.77
|
| Rate for Payer: Cash Price |
$399.86
|
| Rate for Payer: Cigna Commercial |
$639.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$639.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$639.77
|
| Rate for Payer: Multiplan Commercial |
$743.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$679.75
|
| Rate for Payer: United Healthcare Commercial |
$759.72
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9812819002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$582.35 |
| Rate for Payer: Aetna of VT Commercial |
$582.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$549.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$369.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$521.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$496.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$275.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$487.33
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$490.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$490.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$275.85
|
| Rate for Payer: Multiplan Commercial |
$570.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$521.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.85
|
| Rate for Payer: United Healthcare VA CCN |
$275.85
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
5102819001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$752.00 |
| Rate for Payer: Aetna of VT Commercial |
$752.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$716.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$408.68
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$240.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$365.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$365.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$225.75
|
| Rate for Payer: Multiplan Commercial |
$744.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$194.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare VA CCN |
$126.50
|
|
|
RMVL OF FOOT FOREIGN BODY SUBQ
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
9602819001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,045.02 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,045.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,045.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,200.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,186.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,129.60
|
| Rate for Payer: Cash Price |
$706.00
|
| Rate for Payer: Cigna Commercial |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,129.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,129.60
|
| Rate for Payer: Multiplan Commercial |
$1,313.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,200.20
|
| Rate for Payer: United Healthcare Commercial |
$1,341.40
|
|
