|
TRIM NAIL(S)
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
510G012701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna of VT Commercial |
$76.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.39
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$75.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.45
|
| Rate for Payer: United Healthcare VA CCN |
$36.45
|
|
|
TRIM NAIL(S)
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$122.74 |
| Rate for Payer: Aetna of VT Commercial |
$62.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.14
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.01
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NAIL(S)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.85 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna of VT Commercial |
$62.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.80
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$61.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.10
|
| Rate for Payer: United Healthcare Commercial |
$62.70
|
|
|
TRIM NAIL(S)
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
960G012701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$137.24 |
| Rate for Payer: Aetna of VT Commercial |
$137.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.14
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.01
|
| Rate for Payer: Multiplan Commercial |
$135.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna of VT Commercial |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.10
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$7.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9821171901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.08
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare VA CCN |
$10.80
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.08
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.80
|
| Rate for Payer: United Healthcare VA CCN |
$10.80
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna of VT Commercial |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.34
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$49.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.40
|
| Rate for Payer: United Healthcare VA CCN |
$23.40
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna of VT Commercial |
$49.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.60
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$41.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.20
|
| Rate for Payer: United Healthcare Commercial |
$49.40
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna of VT Commercial |
$26.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.26
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$22.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$26.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare VA CCN |
$12.60
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5101171901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna of VT Commercial |
$26.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.40
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$22.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$26.60
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9821171901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of VT Commercial |
$22.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.10
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$7.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$48.88 |
| Rate for Payer: Aetna of VT Commercial |
$48.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.10
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$7.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$48.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9601171902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna of VT Commercial |
$22.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.10
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$7.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare VA CCN |
$6.95
|
|
|
TRIM NONDYSTROPH NAILS ANY NUM
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
9821171901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna of VT Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$22.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
|
|
TROCR CATH 12F
|
Facility
|
OP
|
$25.75
|
|
| Hospital Charge Code |
2720019871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna of VT Commercial |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.47
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cigna Commercial |
$20.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$23.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.59
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.59
|
| Rate for Payer: United Healthcare VA CCN |
$11.59
|
|
|
TROCR CATH 12F
|
Facility
|
IP
|
$25.75
|
|
| Hospital Charge Code |
2720019871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna of VT Commercial |
$24.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.60
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cigna Commercial |
$20.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.60
|
| Rate for Payer: Multiplan Commercial |
$23.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.89
|
| Rate for Payer: United Healthcare Commercial |
$24.46
|
|
|
TROCR CATH 24F
|
Facility
|
OP
|
$21.06
|
|
| Hospital Charge Code |
2720019901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna of VT Commercial |
$20.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.74
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cigna Commercial |
$16.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.48
|
| Rate for Payer: Multiplan Commercial |
$19.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.48
|
| Rate for Payer: United Healthcare VA CCN |
$9.48
|
|
|
TROCR CATH 24F
|
Facility
|
IP
|
$21.06
|
|
| Hospital Charge Code |
2720019901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna of VT Commercial |
$20.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.85
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: Cigna Commercial |
$16.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$19.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.90
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
|
|
TROCR CATH 28F
|
Facility
|
OP
|
$20.29
|
|
| Hospital Charge Code |
2720019911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna of VT Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.13
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cigna Commercial |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$18.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.13
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.13
|
| Rate for Payer: United Healthcare VA CCN |
$9.13
|
|
|
TROCR CATH 28F
|
Facility
|
IP
|
$20.29
|
|
| Hospital Charge Code |
2720019911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna of VT Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.23
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cigna Commercial |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$18.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
|
|
TROCR CATH 32F
|
Facility
|
IP
|
$20.29
|
|
| Hospital Charge Code |
2720019921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna of VT Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.23
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cigna Commercial |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$18.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
|
|
TROCR CATH 32F
|
Facility
|
OP
|
$20.29
|
|
| Hospital Charge Code |
2720019921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna of VT Commercial |
$19.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.13
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cigna Commercial |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$18.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.13
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.13
|
| Rate for Payer: United Healthcare VA CCN |
$9.13
|
|
|
TTE F-UP OR LMTD
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
9819330802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$360.02 |
| Rate for Payer: Aetna of VT Commercial |
$360.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.67
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$218.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$150.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$150.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.29
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.30
|
| Rate for Payer: United Healthcare VA CCN |
$93.30
|
|
