|
ANTIBODY HERPES SMPLX TYPE 1
|
Professional
|
Both
|
$150.96
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3008669501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$141.90 |
| Rate for Payer: Aetna of VT Commercial |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.55
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$140.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$20.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$13.19
|
|
|
ANTIBODY HERPES SMPLX TYPE 1
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3008669501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$143.41 |
| Rate for Payer: Aetna of VT Commercial |
$143.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$122.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.01
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cigna Commercial |
$120.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.93
|
| Rate for Payer: Multiplan Commercial |
$140.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.93
|
| Rate for Payer: United Healthcare Commercial |
$143.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare VA CCN |
$67.93
|
|
|
ANTIBODY HERPES SMPLX TYPE 2
|
Facility
|
OP
|
$157.09
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3008669601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$149.24 |
| Rate for Payer: Aetna of VT Commercial |
$149.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.89
|
| Rate for Payer: Cash Price |
$78.54
|
| Rate for Payer: Cash Price |
$78.54
|
| Rate for Payer: Cigna Commercial |
$125.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.69
|
| Rate for Payer: Multiplan Commercial |
$146.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.69
|
| Rate for Payer: United Healthcare Commercial |
$149.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare VA CCN |
$70.69
|
|
|
ANTIBODY HERPES SMPLX TYPE 2
|
Professional
|
Both
|
$157.09
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3008669601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$147.66 |
| Rate for Payer: Aetna of VT Commercial |
$147.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.07
|
| Rate for Payer: Cash Price |
$78.54
|
| Rate for Payer: Cash Price |
$78.54
|
| Rate for Payer: Cigna Commercial |
$23.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$146.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$29.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare VA CCN |
$19.35
|
|
|
ANTIBODY HERPES SMPLX TYPE 2
|
Facility
|
IP
|
$157.09
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3008669601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.26 |
| Max. Negotiated Rate |
$149.24 |
| Rate for Payer: Aetna of VT Commercial |
$149.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$125.67
|
| Rate for Payer: Cash Price |
$78.54
|
| Rate for Payer: Cigna Commercial |
$125.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.67
|
| Rate for Payer: Multiplan Commercial |
$146.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.53
|
| Rate for Payer: United Healthcare Commercial |
$149.24
|
|
|
ANTIBODY HIV-1
|
Facility
|
IP
|
$99.66
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3008670101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna of VT Commercial |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.73
|
| Rate for Payer: Cash Price |
$49.83
|
| Rate for Payer: Cigna Commercial |
$79.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.73
|
| Rate for Payer: Multiplan Commercial |
$92.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.71
|
| Rate for Payer: United Healthcare Commercial |
$94.68
|
|
|
ANTIBODY HIV-1
|
Facility
|
OP
|
$99.66
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3008670101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$94.68 |
| Rate for Payer: Aetna of VT Commercial |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.23
|
| Rate for Payer: Cash Price |
$49.83
|
| Rate for Payer: Cash Price |
$49.83
|
| Rate for Payer: Cigna Commercial |
$79.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$79.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$79.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$92.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$84.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.85
|
| Rate for Payer: United Healthcare Commercial |
$94.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare VA CCN |
$44.85
|
|
|
ANTIBODY HIV-1
|
Professional
|
Both
|
$99.66
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
3008670101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$93.68 |
| Rate for Payer: Aetna of VT Commercial |
$93.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$43.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.19
|
| Rate for Payer: Cash Price |
$49.83
|
| Rate for Payer: Cash Price |
$49.83
|
| Rate for Payer: Cigna Commercial |
$10.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$92.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: United Healthcare VA CCN |
$8.89
|
|
|
ANTIBODY HIV-2
|
Facility
|
IP
|
$131.67
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
3008670201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna of VT Commercial |
$125.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.34
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna Commercial |
$105.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.34
|
| Rate for Payer: Multiplan Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.92
|
| Rate for Payer: United Healthcare Commercial |
$125.09
|
|
|
ANTIBODY HIV-2
|
Facility
|
OP
|
$131.67
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
3008670201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$125.09 |
| Rate for Payer: Aetna of VT Commercial |
$125.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.68
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna Commercial |
$105.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.25
|
| Rate for Payer: United Healthcare Commercial |
$125.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: United Healthcare VA CCN |
$59.25
|
|
|
ANTIBODY HIV-2
|
Professional
|
Both
|
$131.67
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
3008670201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Aetna of VT Commercial |
$123.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.10
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cash Price |
$65.83
|
| Rate for Payer: Cigna Commercial |
$16.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.33
|
| Rate for Payer: Multiplan Commercial |
$122.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.52
|
| Rate for Payer: United Healthcare Commercial |
$20.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: United Healthcare VA CCN |
$13.52
|
|
|
ANTIBODY MUMPS
|
Professional
|
Both
|
$126.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3008673501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna of VT Commercial |
$118.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.31
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$117.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$20.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare VA CCN |
$13.05
|
|
|
ANTIBODY MUMPS
|
Facility
|
IP
|
$126.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3008673501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$119.84 |
| Rate for Payer: Aetna of VT Commercial |
$119.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.92
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: Cigna Commercial |
$100.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.92
|
| Rate for Payer: Multiplan Commercial |
$117.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.23
|
| Rate for Payer: United Healthcare Commercial |
$119.84
|
|
|
ANTIBODY MUMPS
|
Facility
|
OP
|
$126.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
3008673501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$119.84 |
| Rate for Payer: Aetna of VT Commercial |
$119.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.29
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: Cigna Commercial |
$100.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.77
|
| Rate for Payer: Multiplan Commercial |
$117.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.77
|
| Rate for Payer: United Healthcare Commercial |
$119.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare VA CCN |
$56.77
|
|
|
ANTIBODY MYCOPLSM
|
Facility
|
IP
|
$196.46
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3008673801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.40 |
| Max. Negotiated Rate |
$186.64 |
| Rate for Payer: Aetna of VT Commercial |
$186.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.17
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.17
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.99
|
| Rate for Payer: United Healthcare Commercial |
$186.64
|
|
|
ANTIBODY MYCOPLSM
|
Facility
|
OP
|
$196.46
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3008673801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$186.64 |
| Rate for Payer: Aetna of VT Commercial |
$186.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.19
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.41
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.41
|
| Rate for Payer: United Healthcare Commercial |
$186.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare VA CCN |
$88.41
|
|
|
ANTIBODY MYCOPLSM
|
Professional
|
Both
|
$196.46
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3008673801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Aetna of VT Commercial |
$184.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.26
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$182.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$20.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare VA CCN |
$13.24
|
|
|
ANTIBODY PARVOVIRUS
|
Professional
|
Both
|
$206.96
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3008674701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$194.54 |
| Rate for Payer: Aetna of VT Commercial |
$194.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.05
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna Commercial |
$18.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$192.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare VA CCN |
$15.03
|
|
|
ANTIBODY PARVOVIRUS
|
Facility
|
IP
|
$206.96
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3008674701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.17 |
| Max. Negotiated Rate |
$196.61 |
| Rate for Payer: Aetna of VT Commercial |
$196.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.57
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna Commercial |
$165.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.57
|
| Rate for Payer: Multiplan Commercial |
$192.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.92
|
| Rate for Payer: United Healthcare Commercial |
$196.61
|
|
|
ANTIBODY PARVOVIRUS
|
Facility
|
OP
|
$206.96
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3008674701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$196.61 |
| Rate for Payer: Aetna of VT Commercial |
$196.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.53
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cash Price |
$103.48
|
| Rate for Payer: Cigna Commercial |
$165.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.13
|
| Rate for Payer: Multiplan Commercial |
$192.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.13
|
| Rate for Payer: United Healthcare Commercial |
$196.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare VA CCN |
$93.13
|
|
|
ANTIBODY PROTOZOA NES
|
Professional
|
Both
|
$138.21
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3008675301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$129.92 |
| Rate for Payer: Aetna of VT Commercial |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.02
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$128.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$19.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare VA CCN |
$12.39
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
OP
|
$138.21
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3008675301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna of VT Commercial |
$131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$109.88
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cigna Commercial |
$110.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.19
|
| Rate for Payer: Multiplan Commercial |
$128.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.19
|
| Rate for Payer: United Healthcare Commercial |
$131.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare VA CCN |
$62.19
|
|
|
ANTIBODY PROTOZOA NES
|
Facility
|
IP
|
$138.21
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3008675301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna of VT Commercial |
$131.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.57
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cigna Commercial |
$110.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.57
|
| Rate for Payer: Multiplan Commercial |
$128.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.48
|
| Rate for Payer: United Healthcare Commercial |
$131.30
|
|
|
ANTIBODY RUBELLA
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3008676201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.83
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
|
|
ANTIBODY RUBELLA
|
Professional
|
Both
|
$168.54
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3008676201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$158.43 |
| Rate for Payer: Aetna of VT Commercial |
$158.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.61
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
