|
ALLERGEN SPECIFIC IGG
|
Professional
|
Both
|
$142.31
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
3008600101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$133.77 |
| Rate for Payer: Aetna of VT Commercial |
$133.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.75
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cash Price |
$71.16
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$132.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Commercial |
$12.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare VA CCN |
$7.82
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
5109519901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$190.82 |
| Rate for Payer: Aetna of VT Commercial |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.87
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$188.79
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare VA CCN |
$81.20
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
9829519901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$33.84 |
| Rate for Payer: Aetna of VT Commercial |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare VA CCN |
$14.40
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
5109519901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.24 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna of VT Commercial |
$192.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.40
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$162.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$188.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.55
|
| Rate for Payer: United Healthcare Commercial |
$192.85
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
5109519901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.91 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Aetna of VT Commercial |
$192.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$89.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$172.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.38
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cigna Commercial |
$162.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.35
|
| Rate for Payer: Multiplan Commercial |
$188.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$172.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.35
|
| Rate for Payer: United Healthcare Commercial |
$192.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.35
|
| Rate for Payer: United Healthcare VA CCN |
$91.35
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
9829519901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare VA CCN |
$16.20
|
|
|
ALLERGY IMMUNOLOGY SERVICES
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
9829519901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of VT Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$33.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.60
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
|
|
ALLERGY TESTING
|
Facility
|
IP
|
$10.34
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna of VT Commercial |
$9.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.27
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cigna Commercial |
$8.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.79
|
| Rate for Payer: United Healthcare Commercial |
$9.82
|
|
|
ALLERGY TESTING
|
Professional
|
Both
|
$10.34
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$25.72 |
| Rate for Payer: Aetna of VT Commercial |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.92
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$8.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare VA CCN |
$5.22
|
|
|
ALLERGY TESTING
|
Facility
|
OP
|
$10.34
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$25.72 |
| Rate for Payer: Aetna of VT Commercial |
$9.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.22
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cigna Commercial |
$8.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.65
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$9.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare VA CCN |
$4.65
|
|
|
ALLG SPEC IGE CRUDE XTRC EA
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of VT Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.27
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.15
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare VA CCN |
$30.15
|
|
|
ALLG SPEC IGE CRUDE XTRC EA
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$62.98 |
| Rate for Payer: Aetna of VT Commercial |
$62.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.92
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$8.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare VA CCN |
$5.22
|
|
|
ALLG SPEC IGE CRUDE XTRC EA
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
3008600301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of VT Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.60
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.95
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
|
|
ALLG SPEC IGE RECOMB EA
|
Professional
|
Both
|
$33.75
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
3008600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.62
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna Commercial |
$21.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$31.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare VA CCN |
$17.93
|
|
|
ALLG SPEC IGE RECOMB EA
|
Facility
|
OP
|
$33.75
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
3008600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna of VT Commercial |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.83
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna Commercial |
$27.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.19
|
| Rate for Payer: Multiplan Commercial |
$31.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.19
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare VA CCN |
$15.19
|
|
|
ALLG SPEC IGE RECOMB EA
|
Facility
|
IP
|
$33.75
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
3008600801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Aetna of VT Commercial |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.00
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna Commercial |
$27.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$31.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.69
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
|
|
ALLOGRAFT KIT
|
Facility
|
OP
|
$3,369.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780051331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.49 |
| Max. Negotiated Rate |
$3,201.32 |
| Rate for Payer: Aetna of VT Commercial |
$3,201.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,019.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,492.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,019.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,028.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,864.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,729.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,516.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,679.00
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: Cigna Commercial |
$2,695.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,695.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,695.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,516.41
|
| Rate for Payer: Multiplan Commercial |
$3,133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,864.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,516.41
|
| Rate for Payer: United Healthcare Commercial |
$3,201.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,516.41
|
| Rate for Payer: United Healthcare VA CCN |
$1,516.41
|
|
|
ALLOGRAFT KIT
|
Facility
|
IP
|
$3,369.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780051331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.00 |
| Max. Negotiated Rate |
$3,201.32 |
| Rate for Payer: Aetna of VT Commercial |
$3,201.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,494.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,494.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,864.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,830.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,695.85
|
| Rate for Payer: Cash Price |
$1,684.90
|
| Rate for Payer: Cigna Commercial |
$2,695.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,695.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,695.85
|
| Rate for Payer: Multiplan Commercial |
$3,133.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,864.34
|
| Rate for Payer: United Healthcare Commercial |
$3,201.32
|
|
|
ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
|
OP
|
$97.94
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
3008210401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$93.04 |
| Rate for Payer: Aetna of VT Commercial |
$93.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.86
|
| Rate for Payer: Cash Price |
$48.97
|
| Rate for Payer: Cash Price |
$48.97
|
| Rate for Payer: Cigna Commercial |
$78.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.07
|
| Rate for Payer: Multiplan Commercial |
$91.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.07
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: United Healthcare VA CCN |
$44.07
|
|
|
ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
|
IP
|
$97.94
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
3008210401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$93.04 |
| Rate for Payer: Aetna of VT Commercial |
$93.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.35
|
| Rate for Payer: Cash Price |
$48.97
|
| Rate for Payer: Cigna Commercial |
$78.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.35
|
| Rate for Payer: Multiplan Commercial |
$91.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.25
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
|
|
ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Professional
|
Both
|
$97.94
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
3008210401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Aetna of VT Commercial |
$92.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.71
|
| Rate for Payer: Cash Price |
$48.97
|
| Rate for Payer: Cash Price |
$48.97
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.26
|
| Rate for Payer: Multiplan Commercial |
$91.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.46
|
| Rate for Payer: United Healthcare Commercial |
$22.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: United Healthcare VA CCN |
$14.46
|
|
|
ALPHA-1-ANTITRYPSIN TOTAL
|
Professional
|
Both
|
$141.35
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
3008210301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$132.87 |
| Rate for Payer: Aetna of VT Commercial |
$132.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.97
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cigna Commercial |
$16.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$20.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare VA CCN |
$13.44
|
|
|
ALPHA-1-ANTITRYPSIN TOTAL
|
Facility
|
OP
|
$141.35
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
3008210301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$134.28 |
| Rate for Payer: Aetna of VT Commercial |
$134.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.37
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cigna Commercial |
$113.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.61
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.61
|
| Rate for Payer: United Healthcare Commercial |
$134.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare VA CCN |
$63.61
|
|
|
ALPHA-1-ANTITRYPSIN TOTAL
|
Facility
|
IP
|
$141.35
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
3008210301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$134.28 |
| Rate for Payer: Aetna of VT Commercial |
$134.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.08
|
| Rate for Payer: Cash Price |
$70.67
|
| Rate for Payer: Cigna Commercial |
$113.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.08
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.15
|
| Rate for Payer: United Healthcare Commercial |
$134.28
|
|
|
ALPHA-FETOPROTEIN SERUM
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
3008210501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.76 |
| Max. Negotiated Rate |
$219.18 |
| Rate for Payer: Aetna of VT Commercial |
$219.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.58
|
| Rate for Payer: Cash Price |
$115.36
|
| Rate for Payer: Cigna Commercial |
$184.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.58
|
| Rate for Payer: Multiplan Commercial |
$214.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.11
|
| Rate for Payer: United Healthcare Commercial |
$219.18
|
|
