|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
9825235601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$801.53 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$801.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$801.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$909.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$866.40
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$866.40
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$920.55
|
| Rate for Payer: United Healthcare Commercial |
$1,028.85
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
9825235601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$479.66 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$479.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$651.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$877.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$487.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$860.99
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$866.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.35
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$920.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$487.35
|
| Rate for Payer: United Healthcare Commercial |
$1,028.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$487.35
|
| Rate for Payer: United Healthcare VA CCN |
$487.35
|
|
|
CYSTOURETERO W/LITHOTRIPSY
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
9825235301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$1,582.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,582.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,508.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,508.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$739.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$739.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$739.33
|
| Rate for Payer: Cash Price |
$842.00
|
| Rate for Payer: Cash Price |
$842.00
|
| Rate for Payer: Cigna Commercial |
$627.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$1,566.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOURETERO W/LITHOTRIPSY
|
Facility
|
OP
|
$1,684.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
9825235301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$745.84 |
| Max. Negotiated Rate |
$1,599.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,599.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,508.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$745.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,508.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,013.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,431.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,364.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,338.78
|
| Rate for Payer: Cash Price |
$842.00
|
| Rate for Payer: Cigna Commercial |
$1,347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,347.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$757.80
|
| Rate for Payer: Multiplan Commercial |
$1,566.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,431.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$757.80
|
| Rate for Payer: United Healthcare Commercial |
$1,599.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$757.80
|
| Rate for Payer: United Healthcare VA CCN |
$757.80
|
|
|
CYSTOURETERO W/LITHOTRIPSY
|
Facility
|
IP
|
$1,684.00
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
9825235301
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,246.33 |
| Max. Negotiated Rate |
$1,599.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,599.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,246.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,246.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,431.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,414.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,347.20
|
| Rate for Payer: Cash Price |
$842.00
|
| Rate for Payer: Cigna Commercial |
$1,347.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,347.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,347.20
|
| Rate for Payer: Multiplan Commercial |
$1,566.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,431.40
|
| Rate for Payer: United Healthcare Commercial |
$1,599.80
|
|
|
CYSTOURETERO W/STONE REMOVE
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
9825235201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,063.52 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,365.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,063.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,063.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,221.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,207.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,149.60
|
| Rate for Payer: Cash Price |
$718.50
|
| Rate for Payer: Cigna Commercial |
$1,149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,149.60
|
| Rate for Payer: Multiplan Commercial |
$1,336.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,221.45
|
| Rate for Payer: United Healthcare Commercial |
$1,365.15
|
|
|
CYSTOURETERO W/STONE REMOVE
|
Professional
|
Both
|
$1,437.00
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
9825235201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$326.51 |
| Max. Negotiated Rate |
$1,350.78 |
| Rate for Payer: Aetna of VT Commercial |
$1,350.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,287.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$336.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,287.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$457.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$640.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$640.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$375.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.65
|
| Rate for Payer: Cash Price |
$718.50
|
| Rate for Payer: Cash Price |
$718.50
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$540.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$540.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$326.51
|
| Rate for Payer: Multiplan Commercial |
$1,336.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$463.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$326.51
|
| Rate for Payer: United Healthcare Commercial |
$502.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.51
|
| Rate for Payer: United Healthcare VA CCN |
$326.51
|
|
|
CYSTOURETERO W/STONE REMOVE
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
9825235201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$636.45 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Aetna of VT Commercial |
$1,365.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,287.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$636.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,287.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$865.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,221.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,163.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$646.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,142.41
|
| Rate for Payer: Cash Price |
$718.50
|
| Rate for Payer: Cigna Commercial |
$1,149.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,149.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,149.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$646.65
|
| Rate for Payer: Multiplan Commercial |
$1,336.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,221.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$646.65
|
| Rate for Payer: United Healthcare Commercial |
$1,365.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$646.65
|
| Rate for Payer: United Healthcare VA CCN |
$646.65
|
|
|
CYTOGENETICS 100-300
|
Facility
|
IP
|
$170.91
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
3008827501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$162.36 |
| Rate for Payer: Aetna of VT Commercial |
$162.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.73
|
| Rate for Payer: Cash Price |
$85.46
|
| Rate for Payer: Cigna Commercial |
$136.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.73
|
| Rate for Payer: Multiplan Commercial |
$158.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.27
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
|
|
CYTOGENETICS 100-300
|
Facility
|
OP
|
$170.91
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
3008827501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$252.24 |
| Rate for Payer: Aetna of VT Commercial |
$162.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.87
|
| Rate for Payer: Cash Price |
$85.46
|
| Rate for Payer: Cash Price |
$85.46
|
| Rate for Payer: Cigna Commercial |
$136.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.91
|
| Rate for Payer: Multiplan Commercial |
$158.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.91
|
| Rate for Payer: United Healthcare Commercial |
$162.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare VA CCN |
$76.91
|
|
|
CYTOGENETICS 100-300
|
Professional
|
Both
|
$170.91
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
3008827501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$252.24 |
| Rate for Payer: Aetna of VT Commercial |
$160.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$252.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$252.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.41
|
| Rate for Payer: Cash Price |
$85.46
|
| Rate for Payer: Cash Price |
$85.46
|
| Rate for Payer: Cigna Commercial |
$61.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.47
|
| Rate for Payer: Multiplan Commercial |
$158.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare VA CCN |
$51.19
|
|
|
CYTOGENETICS DNA PROBE
|
Facility
|
OP
|
$196.98
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
3008827101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$187.13 |
| Rate for Payer: Aetna of VT Commercial |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.60
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.64
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.64
|
| Rate for Payer: United Healthcare Commercial |
$187.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare VA CCN |
$88.64
|
|
|
CYTOGENETICS DNA PROBE
|
Facility
|
IP
|
$196.98
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
3008827101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$187.13 |
| Rate for Payer: Aetna of VT Commercial |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.58
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.58
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.43
|
| Rate for Payer: United Healthcare Commercial |
$187.13
|
|
|
CYTOGENETICS DNA PROBE
|
Professional
|
Both
|
$196.98
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
3008827101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Aetna of VT Commercial |
$185.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.61
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cash Price |
$98.49
|
| Rate for Payer: Cigna Commercial |
$25.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$183.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare Commercial |
$32.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare VA CCN |
$21.42
|
|
|
CYTOMEG DNA AMP PROBE
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
3008749601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.32 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$181.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
|
|
CYTOMEG DNA AMP PROBE
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
3008749601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$230.30 |
| Rate for Payer: Aetna of VT Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.98
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
CYTOMEG DNA AMP PROBE
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
3008749601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna of VT Commercial |
$232.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$108.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$147.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.78
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$196.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$196.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$227.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$232.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$110.25
|
|
|
CYTO/MOLECULAR REPORT
|
Facility
|
IP
|
$949.86
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3008829101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$702.99 |
| Max. Negotiated Rate |
$902.37 |
| Rate for Payer: Aetna of VT Commercial |
$902.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$702.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$702.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$807.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$797.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$759.89
|
| Rate for Payer: Cash Price |
$474.93
|
| Rate for Payer: Cigna Commercial |
$759.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$759.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$759.89
|
| Rate for Payer: Multiplan Commercial |
$883.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$807.38
|
| Rate for Payer: United Healthcare Commercial |
$902.37
|
|
|
CYTO/MOLECULAR REPORT
|
Professional
|
Both
|
$949.86
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3008829101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$892.87 |
| Rate for Payer: Aetna of VT Commercial |
$892.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.95
|
| Rate for Payer: Cash Price |
$474.93
|
| Rate for Payer: Cash Price |
$474.93
|
| Rate for Payer: Cigna Commercial |
$39.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.57
|
| Rate for Payer: Multiplan Commercial |
$883.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.57
|
| Rate for Payer: United Healthcare Commercial |
$50.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.57
|
| Rate for Payer: United Healthcare VA CCN |
$32.57
|
|
|
CYTO/MOLECULAR REPORT
|
Facility
|
OP
|
$949.86
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3008829101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$902.37 |
| Rate for Payer: Aetna of VT Commercial |
$902.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$420.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$571.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$807.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$769.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$427.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$755.14
|
| Rate for Payer: Cash Price |
$474.93
|
| Rate for Payer: Cash Price |
$474.93
|
| Rate for Payer: Cigna Commercial |
$759.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$759.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$759.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$427.44
|
| Rate for Payer: Multiplan Commercial |
$883.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$807.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$427.44
|
| Rate for Payer: United Healthcare Commercial |
$902.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.57
|
| Rate for Payer: United Healthcare VA CCN |
$427.44
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
OP
|
$407.91
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
3008811201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$387.51 |
| Rate for Payer: Aetna of VT Commercial |
$387.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$180.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$183.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$324.29
|
| Rate for Payer: Cash Price |
$203.96
|
| Rate for Payer: Cash Price |
$203.96
|
| Rate for Payer: Cigna Commercial |
$326.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$183.56
|
| Rate for Payer: Multiplan Commercial |
$379.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$183.56
|
| Rate for Payer: United Healthcare Commercial |
$387.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.02
|
| Rate for Payer: United Healthcare VA CCN |
$183.56
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Professional
|
Both
|
$407.91
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
3008811201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$383.44 |
| Rate for Payer: Aetna of VT Commercial |
$383.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.26
|
| Rate for Payer: Cash Price |
$203.96
|
| Rate for Payer: Cash Price |
$203.96
|
| Rate for Payer: Cigna Commercial |
$80.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$104.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$104.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.02
|
| Rate for Payer: Multiplan Commercial |
$379.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.02
|
| Rate for Payer: United Healthcare Commercial |
$100.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.02
|
| Rate for Payer: United Healthcare VA CCN |
$65.02
|
|
|
CYTOPATH CELL ENHANCE TECH
|
Facility
|
IP
|
$407.91
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
3008811201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$301.89 |
| Max. Negotiated Rate |
$387.51 |
| Rate for Payer: Aetna of VT Commercial |
$387.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$301.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$301.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.33
|
| Rate for Payer: Cash Price |
$203.96
|
| Rate for Payer: Cigna Commercial |
$326.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$326.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$326.33
|
| Rate for Payer: Multiplan Commercial |
$379.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.72
|
| Rate for Payer: United Healthcare Commercial |
$387.51
|
|
|
CYTOPATH CONCENTRATE TECH
|
Facility
|
OP
|
$211.61
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
3008810801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna of VT Commercial |
$201.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.23
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cigna Commercial |
$169.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.22
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.22
|
| Rate for Payer: United Healthcare Commercial |
$201.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.24
|
| Rate for Payer: United Healthcare VA CCN |
$95.22
|
|
|
CYTOPATH CONCENTRATE TECH
|
Professional
|
Both
|
$211.61
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
3008810801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna of VT Commercial |
$198.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$227.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$227.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$102.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.45
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cash Price |
$105.81
|
| Rate for Payer: Cigna Commercial |
$81.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.24
|
| Rate for Payer: United Healthcare Commercial |
$103.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.24
|
| Rate for Payer: United Healthcare VA CCN |
$67.24
|
|
