|
DETECT AGENT NOS DNA AMP
|
Facility
|
IP
|
$413.96
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3008779801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$306.37 |
| Max. Negotiated Rate |
$393.26 |
| Rate for Payer: Aetna of VT Commercial |
$393.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$347.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.17
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cigna Commercial |
$331.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.17
|
| Rate for Payer: Multiplan Commercial |
$384.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.87
|
| Rate for Payer: United Healthcare Commercial |
$393.26
|
|
|
DETECT AGENT NOS DNA QUANT
|
Professional
|
Both
|
$970.93
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$912.67 |
| Rate for Payer: Aetna of VT Commercial |
$912.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.22
|
| Rate for Payer: Cash Price |
$485.46
|
| Rate for Payer: Cash Price |
$485.46
|
| Rate for Payer: Cigna Commercial |
$51.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$902.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$65.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$42.84
|
|
|
DETECT AGENT NOS DNA QUANT
|
Facility
|
OP
|
$970.93
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$922.38 |
| Rate for Payer: Aetna of VT Commercial |
$922.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$430.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$584.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$825.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$436.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$771.89
|
| Rate for Payer: Cash Price |
$485.46
|
| Rate for Payer: Cash Price |
$485.46
|
| Rate for Payer: Cigna Commercial |
$776.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$776.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$776.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$436.92
|
| Rate for Payer: Multiplan Commercial |
$902.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$825.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$436.92
|
| Rate for Payer: United Healthcare Commercial |
$922.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$436.92
|
|
|
DETECT AGENT NOS DNA QUANT
|
Facility
|
IP
|
$970.93
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3008779901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$718.59 |
| Max. Negotiated Rate |
$922.38 |
| Rate for Payer: Aetna of VT Commercial |
$922.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$718.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$718.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$825.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$815.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$776.74
|
| Rate for Payer: Cash Price |
$485.46
|
| Rate for Payer: Cigna Commercial |
$776.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$776.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$776.74
|
| Rate for Payer: Multiplan Commercial |
$902.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$825.29
|
| Rate for Payer: United Healthcare Commercial |
$922.38
|
|
|
DETECT AGNT MULT DNA AMPLI
|
Facility
|
OP
|
$312.49
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3008780101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$345.91 |
| Rate for Payer: Aetna of VT Commercial |
$296.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$345.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$138.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$345.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$188.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.43
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cigna Commercial |
$249.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$140.62
|
| Rate for Payer: Multiplan Commercial |
$290.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.62
|
| Rate for Payer: United Healthcare Commercial |
$296.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$140.62
|
|
|
DETECT AGNT MULT DNA AMPLI
|
Facility
|
IP
|
$312.49
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
3008780101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$231.27 |
| Max. Negotiated Rate |
$296.87 |
| Rate for Payer: Aetna of VT Commercial |
$296.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$262.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$249.99
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cigna Commercial |
$249.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$249.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$249.99
|
| Rate for Payer: Multiplan Commercial |
$290.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.62
|
| Rate for Payer: United Healthcare Commercial |
$296.87
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
9189611001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Aetna of VT Commercial |
$39.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.39
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$33.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$39.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$39.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.90
|
| Rate for Payer: United Healthcare VA CCN |
$18.90
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
9189611001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Aetna of VT Commercial |
$39.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.60
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$33.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$39.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$39.90
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
9189611001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna of VT Commercial |
$39.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.66
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$13.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$39.06
|
| Rate for Payer: United Healthcare Commercial |
$35.70
|
| Rate for Payer: United Healthcare VA CCN |
$11.46
|
|
|
DEXAMETHASONE 120 MG/30 ML VIA
|
Professional
|
Both
|
$5.19
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of VT Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.10
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$4.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare VA CCN |
$0.09
|
|
|
DEXAMETHASONE 4 MG/ML VIAL
|
Professional
|
Both
|
$2.76
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna of VT Commercial |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.10
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$2.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare VA CCN |
$0.09
|
|
|
DEXAMETHASONE 4 MG/ML VIAL
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
|
|
DEXAMETHASONE (PF) 10 MG VIAL
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
|
|
DEXAMETHASONE (PF) 10 MG VIAL
|
Professional
|
Both
|
$18.15
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
636J110001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Aetna of VT Commercial |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.10
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.09
|
| Rate for Payer: United Healthcare VA CCN |
$0.09
|
|
|
DEXTROSE 5% 500ML NON PVC BAG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
636J706004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Aetna of VT Commercial |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.13
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$13.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$13.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.30
|
| Rate for Payer: United Healthcare VA CCN |
$6.30
|
|
|
DEXTROSE 5% 500ML NON PVC BAG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
636J706004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$13.30 |
| Rate for Payer: Aetna of VT Commercial |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.20
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.20
|
| Rate for Payer: Multiplan Commercial |
$13.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.90
|
| Rate for Payer: United Healthcare Commercial |
$13.30
|
|
|
DGP ANTIBODY EACH IG CLASS
|
Facility
|
IP
|
$96.16
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
3008625801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.93
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
|
|
DGP ANTIBODY EACH IG CLASS
|
Professional
|
Both
|
$96.16
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
3008625801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna of VT Commercial |
$90.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.60
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
DGP ANTIBODY EACH IG CLASS
|
Facility
|
OP
|
$96.16
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
3008625801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.45
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.27
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.27
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$43.27
|
|
|
DIAG LAPARO SEPARATE PROC
|
Professional
|
Both
|
$1,321.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
9824932001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$304.43 |
| Max. Negotiated Rate |
$1,241.74 |
| Rate for Payer: Aetna of VT Commercial |
$1,241.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,183.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,183.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$426.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$648.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$648.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$350.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$648.17
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cigna Commercial |
$555.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$515.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$515.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$304.43
|
| Rate for Payer: Multiplan Commercial |
$1,228.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$304.43
|
| Rate for Payer: United Healthcare Commercial |
$468.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.43
|
| Rate for Payer: United Healthcare VA CCN |
$304.43
|
|
|
DIAG LAPARO SEPARATE PROC
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
9824932001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$977.67 |
| Max. Negotiated Rate |
$1,254.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$977.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$977.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,122.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,109.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,056.80
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cigna Commercial |
$1,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,056.80
|
| Rate for Payer: Multiplan Commercial |
$1,228.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,122.85
|
| Rate for Payer: United Healthcare Commercial |
$1,254.95
|
|
|
DIAG LAPARO SEPARATE PROC
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
9824932001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$585.07 |
| Max. Negotiated Rate |
$1,254.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,254.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,183.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$585.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,183.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$795.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,122.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,070.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$594.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,050.19
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cigna Commercial |
$1,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,056.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,056.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$594.45
|
| Rate for Payer: Multiplan Commercial |
$1,228.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,122.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$594.45
|
| Rate for Payer: United Healthcare Commercial |
$1,254.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$594.45
|
| Rate for Payer: United Healthcare VA CCN |
$594.45
|
|
|
DIAGNOSTIC ANOSCOPY SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9824660001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$217.14 |
| Rate for Payer: Aetna of VT Commercial |
$217.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.71
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$71.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.07
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare VA CCN |
$39.05
|
|
|
DIAGNOSTIC ANOSCOPY SPX
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9814660002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna of VT Commercial |
$219.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.65
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.95
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$219.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.95
|
| Rate for Payer: United Healthcare VA CCN |
$103.95
|
|
|
DIAGNOSTIC ANOSCOPY SPX
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
9814660001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$217.14 |
| Rate for Payer: Aetna of VT Commercial |
$217.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$40.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.71
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$71.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.07
|
| Rate for Payer: Multiplan Commercial |
$214.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$60.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.05
|
| Rate for Payer: United Healthcare VA CCN |
$39.05
|
|
