|
CO/MEMBANE DIFFUSE CAPACITY
|
Professional
|
Both
|
$336.31
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$316.13 |
| Rate for Payer: Aetna of VT Commercial |
$316.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.86
|
| Rate for Payer: Cash Price |
$168.16
|
| Rate for Payer: Cash Price |
$168.16
|
| Rate for Payer: Cigna Commercial |
$81.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.70
|
| Rate for Payer: Multiplan Commercial |
$312.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.70
|
| Rate for Payer: United Healthcare Commercial |
$82.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.70
|
| Rate for Payer: United Healthcare VA CCN |
$53.70
|
|
|
CO/MEMBANE DIFFUSE CAPACITY
|
Facility
|
OP
|
$336.31
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.95 |
| Max. Negotiated Rate |
$319.49 |
| Rate for Payer: Aetna of VT Commercial |
$319.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$148.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$272.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$267.37
|
| Rate for Payer: Cash Price |
$168.16
|
| Rate for Payer: Cigna Commercial |
$269.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.34
|
| Rate for Payer: Multiplan Commercial |
$312.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$285.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.34
|
| Rate for Payer: United Healthcare Commercial |
$319.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.34
|
| Rate for Payer: United Healthcare VA CCN |
$151.34
|
|
|
CO/MEMBANE DIFFUSE CAPACITY
|
Facility
|
IP
|
$336.31
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$248.90 |
| Max. Negotiated Rate |
$319.49 |
| Rate for Payer: Aetna of VT Commercial |
$319.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$248.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$248.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$285.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$269.05
|
| Rate for Payer: Cash Price |
$168.16
|
| Rate for Payer: Cigna Commercial |
$269.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$269.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$269.05
|
| Rate for Payer: Multiplan Commercial |
$312.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$285.86
|
| Rate for Payer: United Healthcare Commercial |
$319.49
|
|
|
COMMUNITY/WORK REINTEGRATION
|
Facility
|
IP
|
$114.77
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
4209753701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.82
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
|
|
COMMUNITY/WORK REINTEGRATION
|
Facility
|
IP
|
$114.77
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
4309753701
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.82
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
|
|
COMMUNITY/WORK REINTEGRATION
|
Facility
|
OP
|
$114.77
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
4309753701
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.24
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.65
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare VA CCN |
$51.65
|
|
|
COMMUNITY/WORK REINTEGRATION
|
Facility
|
OP
|
$114.77
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
4209753701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.24
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.65
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare VA CCN |
$51.65
|
|
|
COMPATIBILITY TEST ANTIGLOB
|
Facility
|
OP
|
$216.88
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$206.04 |
| Rate for Payer: Aetna of VT Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.42
|
| Rate for Payer: Cash Price |
$108.44
|
| Rate for Payer: Cash Price |
$108.44
|
| Rate for Payer: Cigna Commercial |
$173.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$201.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.60
|
| Rate for Payer: United Healthcare Commercial |
$206.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.60
|
| Rate for Payer: United Healthcare VA CCN |
$97.60
|
|
|
COMPATIBILITY TEST ANTIGLOB
|
Professional
|
Both
|
$216.88
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$203.87 |
| Rate for Payer: Aetna of VT Commercial |
$203.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.28
|
| Rate for Payer: Cash Price |
$108.44
|
| Rate for Payer: Cash Price |
$108.44
|
| Rate for Payer: Cigna Commercial |
$42.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.49
|
| Rate for Payer: Multiplan Commercial |
$201.70
|
| Rate for Payer: United Healthcare Commercial |
$184.35
|
| Rate for Payer: United Healthcare VA CCN |
$47.00
|
|
|
COMPATIBILITY TEST ANTIGLOB
|
Facility
|
IP
|
$216.88
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.51 |
| Max. Negotiated Rate |
$206.04 |
| Rate for Payer: Aetna of VT Commercial |
$206.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.50
|
| Rate for Payer: Cash Price |
$108.44
|
| Rate for Payer: Cigna Commercial |
$173.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.50
|
| Rate for Payer: Multiplan Commercial |
$201.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.35
|
| Rate for Payer: United Healthcare Commercial |
$206.04
|
|
|
COMPATIBILITY TEST SPIN
|
Facility
|
OP
|
$230.25
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$218.74 |
| Rate for Payer: Aetna of VT Commercial |
$218.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.05
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cigna Commercial |
$184.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.61
|
| Rate for Payer: Multiplan Commercial |
$214.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.61
|
| Rate for Payer: United Healthcare Commercial |
$218.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.61
|
| Rate for Payer: United Healthcare VA CCN |
$103.61
|
|
|
COMPATIBILITY TEST SPIN
|
Professional
|
Both
|
$230.25
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$216.44 |
| Rate for Payer: Aetna of VT Commercial |
$216.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$187.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.84
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cigna Commercial |
$40.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.30
|
| Rate for Payer: Multiplan Commercial |
$214.13
|
| Rate for Payer: United Healthcare Commercial |
$195.71
|
| Rate for Payer: United Healthcare VA CCN |
$98.00
|
|
|
COMPATIBILITY TEST SPIN
|
Facility
|
IP
|
$230.25
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.41 |
| Max. Negotiated Rate |
$218.74 |
| Rate for Payer: Aetna of VT Commercial |
$218.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.20
|
| Rate for Payer: Cash Price |
$115.12
|
| Rate for Payer: Cigna Commercial |
$184.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$214.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.71
|
| Rate for Payer: United Healthcare Commercial |
$218.74
|
|
|
COMPLEMENT ANTIGEN EACH COMPON
|
Facility
|
OP
|
$163.59
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3008616001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$155.41 |
| Rate for Payer: Aetna of VT Commercial |
$155.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.05
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cigna Commercial |
$130.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.62
|
| Rate for Payer: Multiplan Commercial |
$152.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.62
|
| Rate for Payer: United Healthcare Commercial |
$155.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare VA CCN |
$73.62
|
|
|
COMPLEMENT ANTIGEN EACH COMPON
|
Facility
|
IP
|
$163.59
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3008616001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.07 |
| Max. Negotiated Rate |
$155.41 |
| Rate for Payer: Aetna of VT Commercial |
$155.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.87
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cigna Commercial |
$130.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.87
|
| Rate for Payer: Multiplan Commercial |
$152.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$155.41
|
|
|
COMPLEMENT ANTIGEN EACH COMPON
|
Professional
|
Both
|
$163.59
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3008616001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$153.77 |
| Rate for Payer: Aetna of VT Commercial |
$153.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.50
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.83
|
| Rate for Payer: Multiplan Commercial |
$152.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$18.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare VA CCN |
$12.00
|
|
|
COMPLEMENT/FUNCTION ACTIVITY
|
Professional
|
Both
|
$114.77
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
3008616101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$107.88 |
| Rate for Payer: Aetna of VT Commercial |
$107.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.50
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.83
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$18.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare VA CCN |
$12.00
|
|
|
COMPLEMENT/FUNCTION ACTIVITY
|
Facility
|
IP
|
$114.77
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
3008616101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.82
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
|
|
COMPLEMENT/FUNCTION ACTIVITY
|
Facility
|
OP
|
$114.77
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
3008616101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Aetna of VT Commercial |
$109.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.24
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna Commercial |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$91.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$91.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.65
|
| Rate for Payer: Multiplan Commercial |
$106.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.65
|
| Rate for Payer: United Healthcare Commercial |
$109.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare VA CCN |
$51.65
|
|
|
COMPLEMENT TOTAL HEMOLYTIC
|
Facility
|
IP
|
$181.73
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
3008616201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.50 |
| Max. Negotiated Rate |
$172.64 |
| Rate for Payer: Aetna of VT Commercial |
$172.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$134.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$134.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$145.38
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cigna Commercial |
$145.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.38
|
| Rate for Payer: Multiplan Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.47
|
| Rate for Payer: United Healthcare Commercial |
$172.64
|
|
|
COMPLEMENT TOTAL HEMOLYTIC
|
Facility
|
OP
|
$181.73
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
3008616201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$172.64 |
| Rate for Payer: Aetna of VT Commercial |
$172.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$109.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.48
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cigna Commercial |
$145.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$145.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$145.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.78
|
| Rate for Payer: Multiplan Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.78
|
| Rate for Payer: United Healthcare Commercial |
$172.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: United Healthcare VA CCN |
$81.78
|
|
|
COMPLEMENT TOTAL HEMOLYTIC
|
Professional
|
Both
|
$181.73
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
3008616201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$170.83 |
| Rate for Payer: Aetna of VT Commercial |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.73
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cash Price |
$90.86
|
| Rate for Payer: Cigna Commercial |
$24.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.04
|
| Rate for Payer: Multiplan Commercial |
$169.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.32
|
| Rate for Payer: United Healthcare Commercial |
$31.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: United Healthcare VA CCN |
$20.32
|
|
|
COMPLETE CBC W/AUTO DIFF WBC
|
Facility
|
OP
|
$84.79
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
3008502501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$80.55 |
| Rate for Payer: Aetna of VT Commercial |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.41
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cigna Commercial |
$67.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.16
|
| Rate for Payer: Multiplan Commercial |
$78.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.16
|
| Rate for Payer: United Healthcare Commercial |
$80.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.77
|
| Rate for Payer: United Healthcare VA CCN |
$38.16
|
|
|
COMPLETE CBC W/AUTO DIFF WBC
|
Facility
|
IP
|
$84.79
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
3008502501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.75 |
| Max. Negotiated Rate |
$80.55 |
| Rate for Payer: Aetna of VT Commercial |
$80.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.83
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cigna Commercial |
$67.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.83
|
| Rate for Payer: Multiplan Commercial |
$78.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.07
|
| Rate for Payer: United Healthcare Commercial |
$80.55
|
|
|
COMPLEX DRAINAGE WOUND
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
9821018001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$313.13 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna of VT Commercial |
$671.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$633.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$600.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$572.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$318.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$562.07
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cigna Commercial |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$565.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$565.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$318.15
|
| Rate for Payer: Multiplan Commercial |
$657.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare Commercial |
$671.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$318.15
|
| Rate for Payer: United Healthcare VA CCN |
$318.15
|
|
