|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9605415002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$172.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$349.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$234.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$175.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$310.05
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.50
|
| Rate for Payer: United Healthcare VA CCN |
$175.50
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
5215415002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$288.64 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna of VT Commercial |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$312.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$362.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$331.50
|
| Rate for Payer: United Healthcare Commercial |
$370.50
|
|
|
CLAVICULECTOMY PARTIAL
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
9822312001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$662.58 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$662.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$900.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,211.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,189.32
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$673.20
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$673.20
|
| Rate for Payer: United Healthcare VA CCN |
$673.20
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
9822312001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$561.10 |
| Max. Negotiated Rate |
$1,406.24 |
| Rate for Payer: Aetna of VT Commercial |
$1,406.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$577.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,340.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$785.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$955.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$955.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$645.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$955.45
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,063.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$931.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$931.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$561.10
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$796.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$561.10
|
| Rate for Payer: United Healthcare Commercial |
$863.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$561.10
|
| Rate for Payer: United Healthcare VA CCN |
$561.10
|
|
|
CLAVICULECTOMY PARTIAL
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
9822312001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,107.19 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna of VT Commercial |
$1,421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,107.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,256.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,196.80
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cigna Commercial |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,196.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,196.80
|
| Rate for Payer: Multiplan Commercial |
$1,391.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,271.60
|
| Rate for Payer: United Healthcare Commercial |
$1,421.20
|
|
|
CLEARANCE OF AIRWAYS
|
Facility
|
IP
|
$270.91
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
4103172001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$200.50 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna of VT Commercial |
$257.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.73
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cigna Commercial |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.73
|
| Rate for Payer: Multiplan Commercial |
$251.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.27
|
| Rate for Payer: United Healthcare Commercial |
$257.36
|
|
|
CLEARANCE OF AIRWAYS
|
Facility
|
OP
|
$270.91
|
|
|
Service Code
|
CPT 31720
|
| Hospital Charge Code |
4103172001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna of VT Commercial |
$257.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.37
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cigna Commercial |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.91
|
| Rate for Payer: Multiplan Commercial |
$251.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.91
|
| Rate for Payer: United Healthcare Commercial |
$257.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.91
|
| Rate for Payer: United Healthcare VA CCN |
$121.91
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9606920002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.60
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9606920001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$182.92 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna of VT Commercial |
$392.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$248.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$334.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.33
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$330.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$330.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$330.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$185.85
|
| Rate for Payer: Multiplan Commercial |
$384.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.85
|
| Rate for Payer: United Healthcare Commercial |
$392.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.85
|
| Rate for Payer: United Healthcare VA CCN |
$185.85
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna of VT Commercial |
$212.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.20
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.20
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.40
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna of VT Commercial |
$212.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.08
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$212.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.80
|
| Rate for Payer: United Healthcare VA CCN |
$100.80
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$141.14
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
4506920001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.51 |
| Max. Negotiated Rate |
$134.08 |
| Rate for Payer: Aetna of VT Commercial |
$134.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.21
|
| Rate for Payer: Cash Price |
$70.57
|
| Rate for Payer: Cigna Commercial |
$112.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.51
|
| Rate for Payer: Multiplan Commercial |
$131.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.51
|
| Rate for Payer: United Healthcare Commercial |
$134.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.51
|
| Rate for Payer: United Healthcare VA CCN |
$63.51
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$141.14
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
4506920001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.46 |
| Max. Negotiated Rate |
$134.08 |
| Rate for Payer: Aetna of VT Commercial |
$134.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.91
|
| Rate for Payer: Cash Price |
$70.57
|
| Rate for Payer: Cigna Commercial |
$112.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$112.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$112.91
|
| Rate for Payer: Multiplan Commercial |
$131.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.97
|
| Rate for Payer: United Healthcare Commercial |
$134.08
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$120.47 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.24
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.40
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare VA CCN |
$122.40
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
9816920502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna of VT Commercial |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$91.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.20
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$87.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$87.20
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.65
|
| Rate for Payer: United Healthcare Commercial |
$103.55
|
|
|
CLEAR OUTER EAR CANAL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$255.68 |
| Rate for Payer: Aetna of VT Commercial |
$255.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.92
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$70.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.06
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.60
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
|
|
CLEAR OUTER EAR CANAL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9816920001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$210.56 |
| Rate for Payer: Aetna of VT Commercial |
$210.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.92
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$70.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.06
|
| Rate for Payer: Multiplan Commercial |
$208.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.89 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.89
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.90
|
| Rate for Payer: United Healthcare VA CCN |
$63.90
|
|
|
CLEAR OUTER EAR CANAL
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9606920001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$388.22 |
| Rate for Payer: Aetna of VT Commercial |
$388.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.92
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$70.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.06
|
| Rate for Payer: Multiplan Commercial |
$384.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna of VT Commercial |
$134.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.60
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.70
|
| Rate for Payer: United Healthcare Commercial |
$134.90
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
IP
|
$371.21
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
4506920501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.73 |
| Max. Negotiated Rate |
$352.65 |
| Rate for Payer: Aetna of VT Commercial |
$352.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$274.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$274.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$315.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$311.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$296.97
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cigna Commercial |
$296.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$296.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$296.97
|
| Rate for Payer: Multiplan Commercial |
$345.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$315.53
|
| Rate for Payer: United Healthcare Commercial |
$352.65
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
9606920002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.47 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of VT Commercial |
$258.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.24
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.40
|
| Rate for Payer: Multiplan Commercial |
$252.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare Commercial |
$258.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Healthcare VA CCN |
$122.40
|
|
|
CLEAR OUTER EAR CANAL
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
9816920502
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$177.88 |
| Rate for Payer: Aetna of VT Commercial |
$102.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.88
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$144.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$101.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare Commercial |
$138.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare VA CCN |
$90.00
|
|
|
CLEAR OUTER EAR CANAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna of VT Commercial |
$133.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.92
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$70.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.06
|
| Rate for Payer: Multiplan Commercial |
$132.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$68.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.58
|
| Rate for Payer: United Healthcare VA CCN |
$44.58
|
|
