|
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
|
|
|
CYTOPATH C/V AUTO FLUID REDO
|
Professional
|
Both
|
$111.67
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
3008817501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna of VT Commercial |
$104.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.48
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cigna Commercial |
$32.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$36.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$36.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.24
|
| Rate for Payer: Multiplan Commercial |
$103.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare Commercial |
$40.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare VA CCN |
$26.61
|
|
|
CYTOPATH C/V AUTO FLUID REDO
|
Facility
|
OP
|
$111.67
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
3008817501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna of VT Commercial |
$106.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$67.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.78
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cigna Commercial |
$89.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$103.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.25
|
| Rate for Payer: United Healthcare Commercial |
$106.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare VA CCN |
$50.25
|
|
|
CYTOPATH C/V AUTO FLUID REDO
|
Facility
|
IP
|
$111.67
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
3008817501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$106.09 |
| Rate for Payer: Aetna of VT Commercial |
$106.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.34
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cigna Commercial |
$89.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$89.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$89.34
|
| Rate for Payer: Multiplan Commercial |
$103.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.92
|
| Rate for Payer: United Healthcare Commercial |
$106.09
|
|
|
CYTOPATH C/V THIN LAYER
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
3008814201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$99.83 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.65
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.90
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.90
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.26
|
| Rate for Payer: United Healthcare VA CCN |
$34.90
|
|
|
CYTOPATH C/V THIN LAYER
|
Professional
|
Both
|
$77.55
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
3008814201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$99.83 |
| Rate for Payer: Aetna of VT Commercial |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.63
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$24.59
|
| 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 |
$19.98
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.26
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.26
|
| Rate for Payer: United Healthcare VA CCN |
$20.26
|
|
|
CYTOPATH C/V THIN LAYER
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
3108814201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$99.83 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.65
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.90
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.90
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.26
|
| Rate for Payer: United Healthcare VA CCN |
$34.90
|
|
|
CYTOPATH C/V THIN LAYER
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
3108814201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.04
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
|
|
CYTOPATH C/V THIN LAYER
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
3008814201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna of VT Commercial |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.04
|
| Rate for Payer: Cash Price |
$38.77
|
| Rate for Payer: Cigna Commercial |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.04
|
| Rate for Payer: Multiplan Commercial |
$72.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.92
|
| Rate for Payer: United Healthcare Commercial |
$73.67
|
|
|
CYTOPATH EVAL FNA REPORT
|
Facility
|
OP
|
$393.44
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3008817301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$484.03 |
| Rate for Payer: Aetna of VT Commercial |
$373.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$236.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$177.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$312.78
|
| Rate for Payer: Cash Price |
$196.72
|
| Rate for Payer: Cash Price |
$196.72
|
| Rate for Payer: Cigna Commercial |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.05
|
| Rate for Payer: Multiplan Commercial |
$365.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.05
|
| Rate for Payer: United Healthcare Commercial |
$373.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.49
|
| Rate for Payer: United Healthcare VA CCN |
$177.05
|
|
|
CYTOPATH EVAL FNA REPORT
|
Professional
|
Both
|
$393.44
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3008817301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$484.03 |
| Rate for Payer: Aetna of VT Commercial |
$369.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$484.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$198.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$189.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.54
|
| Rate for Payer: Cash Price |
$196.72
|
| Rate for Payer: Cash Price |
$196.72
|
| Rate for Payer: Cigna Commercial |
$198.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.49
|
| Rate for Payer: Multiplan Commercial |
$365.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$164.49
|
| Rate for Payer: United Healthcare Commercial |
$253.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.49
|
| Rate for Payer: United Healthcare VA CCN |
$164.49
|
|
|
CYTOPATH EVAL FNA REPORT
|
Facility
|
IP
|
$393.44
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3008817301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$291.18 |
| Max. Negotiated Rate |
$373.77 |
| Rate for Payer: Aetna of VT Commercial |
$373.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.75
|
| Rate for Payer: Cash Price |
$196.72
|
| Rate for Payer: Cigna Commercial |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.75
|
| Rate for Payer: Multiplan Commercial |
$365.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.42
|
| Rate for Payer: United Healthcare Commercial |
$373.77
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
OP
|
$110.64
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
3008816001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$266.23 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$49.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$66.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.96
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$49.79
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$49.79
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.95
|
| Rate for Payer: United Healthcare VA CCN |
$49.79
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Professional
|
Both
|
$110.64
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
3008816001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$266.23 |
| Rate for Payer: Aetna of VT Commercial |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$87.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$87.04
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$94.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.96
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.95
|
| Rate for Payer: United Healthcare Commercial |
$122.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.95
|
| Rate for Payer: United Healthcare VA CCN |
$79.95
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
IP
|
$211.97
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
3008816101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.88 |
| Max. Negotiated Rate |
$201.37 |
| Rate for Payer: Aetna of VT Commercial |
$201.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.58
|
| Rate for Payer: Cash Price |
$105.98
|
| Rate for Payer: Cigna Commercial |
$169.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.58
|
| Rate for Payer: Multiplan Commercial |
$197.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.17
|
| Rate for Payer: United Healthcare Commercial |
$201.37
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
IP
|
$110.64
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
3008816001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna of VT Commercial |
$105.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$88.51
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cigna Commercial |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$88.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$88.51
|
| Rate for Payer: Multiplan Commercial |
$102.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$94.04
|
| Rate for Payer: United Healthcare Commercial |
$105.11
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Facility
|
OP
|
$211.97
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
3008816101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.59 |
| Max. Negotiated Rate |
$275.89 |
| Rate for Payer: Aetna of VT Commercial |
$201.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.52
|
| Rate for Payer: Cash Price |
$105.98
|
| Rate for Payer: Cash Price |
$105.98
|
| Rate for Payer: Cigna Commercial |
$169.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.39
|
| Rate for Payer: Multiplan Commercial |
$197.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.39
|
| Rate for Payer: United Healthcare Commercial |
$201.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare VA CCN |
$95.39
|
|
|
CYTOPATH SMEAR OTHER SOURCE
|
Professional
|
Both
|
$211.97
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
3008816101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.59 |
| Max. Negotiated Rate |
$275.89 |
| Rate for Payer: Aetna of VT Commercial |
$199.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$275.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$275.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$92.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$92.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.74
|
| Rate for Payer: Cash Price |
$105.98
|
| Rate for Payer: Cash Price |
$105.98
|
| Rate for Payer: Cigna Commercial |
$96.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.59
|
| Rate for Payer: Multiplan Commercial |
$197.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare Commercial |
$123.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.59
|
| Rate for Payer: United Healthcare VA CCN |
$80.59
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
IP
|
$406.37
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
3008817201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$386.05 |
| Rate for Payer: Aetna of VT Commercial |
$386.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$300.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$300.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$341.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.10
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.10
|
| Rate for Payer: Multiplan Commercial |
$377.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$386.05
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Professional
|
Both
|
$406.37
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
3008817201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.13 |
| Max. Negotiated Rate |
$381.99 |
| Rate for Payer: Aetna of VT Commercial |
$381.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.59
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$66.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$86.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$86.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.14
|
| Rate for Payer: Multiplan Commercial |
$377.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.13
|
| Rate for Payer: United Healthcare Commercial |
$83.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.13
|
| Rate for Payer: United Healthcare VA CCN |
$54.13
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
OP
|
$406.37
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
3008817201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.13 |
| Max. Negotiated Rate |
$386.05 |
| Rate for Payer: Aetna of VT Commercial |
$386.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$179.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$345.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$329.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$323.06
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.87
|
| Rate for Payer: Multiplan Commercial |
$377.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.87
|
| Rate for Payer: United Healthcare Commercial |
$386.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.13
|
| Rate for Payer: United Healthcare VA CCN |
$182.87
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 7095413510
|
| Hospital Charge Code |
2500000596
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna of VT Commercial |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.75
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna Commercial |
$2.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.75
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 7095413510
|
| Hospital Charge Code |
2500000596
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna of VT Commercial |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.73
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Cigna Commercial |
$2.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.55
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$3.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.55
|
| Rate for Payer: United Healthcare VA CCN |
$1.55
|
|
|
DARBEPOETIN A 500MCG SYR*340B*
|
Facility
|
IP
|
$164.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
636J088108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$155.90 |
| Rate for Payer: Aetna of VT Commercial |
$155.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.28
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.28
|
| Rate for Payer: Multiplan Commercial |
$152.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.49
|
| Rate for Payer: United Healthcare Commercial |
$155.90
|
|
|
DARBEPOETIN A 500MCG SYR*340B*
|
Facility
|
IP
|
$164.10
|
|
|
Service Code
|
HCPCS J0881 TB
|
| Hospital Charge Code |
636J088108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$155.90 |
| Rate for Payer: Aetna of VT Commercial |
$155.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.28
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna Commercial |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.28
|
| Rate for Payer: Multiplan Commercial |
$152.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.49
|
| Rate for Payer: United Healthcare Commercial |
$155.90
|
|
