|
DRUG ASSAY EVEROLIMUS
|
Professional
|
Both
|
$302.96
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3008016901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$284.78 |
| Rate for Payer: Aetna of VT Commercial |
$284.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.19
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$281.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare Commercial |
$21.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare VA CCN |
$13.73
|
|
|
DRUG ASSAY EVEROLIMUS
|
Facility
|
OP
|
$302.96
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3008016901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$287.81 |
| Rate for Payer: Aetna of VT Commercial |
$287.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$136.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$240.85
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cigna Commercial |
$242.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$136.33
|
| Rate for Payer: Multiplan Commercial |
$281.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$136.33
|
| Rate for Payer: United Healthcare Commercial |
$287.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare VA CCN |
$136.33
|
|
|
DRUG ASSAY EVEROLIMUS
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3008016901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$287.81 |
| Rate for Payer: Aetna of VT Commercial |
$287.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$224.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$224.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$257.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$254.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$242.37
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cigna Commercial |
$242.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$242.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$242.37
|
| Rate for Payer: Multiplan Commercial |
$281.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.52
|
| Rate for Payer: United Healthcare Commercial |
$287.81
|
|
|
DRUG ASSAY INFLIXIMAB
|
Facility
|
IP
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$386.04 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| 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 |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.09
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
|
|
DRUG ASSAY INFLIXIMAB
|
Facility
|
OP
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$386.04 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| 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 |
$190.05
|
| 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 |
$329.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.86
|
| 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 |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.86
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.86
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$182.86
|
|
|
DRUG ASSAY INFLIXIMAB
|
Facility
|
OP
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$386.04 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| 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 |
$190.05
|
| 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 |
$329.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.86
|
| 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 |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.86
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$182.86
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$182.86
|
|
|
DRUG ASSAY INFLIXIMAB
|
Professional
|
Both
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$381.98 |
| Rate for Payer: Aetna of VT Commercial |
$381.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.01
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$38.57
|
|
|
DRUG ASSAY INFLIXIMAB
|
Facility
|
IP
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$300.75 |
| Max. Negotiated Rate |
$386.04 |
| Rate for Payer: Aetna of VT Commercial |
$386.04
|
| 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 |
$341.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.09
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$325.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$325.09
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$345.41
|
| Rate for Payer: United Healthcare Commercial |
$386.04
|
|
|
DRUG ASSAY INFLIXIMAB
|
Professional
|
Both
|
$406.36
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
3008023000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$381.98 |
| Rate for Payer: Aetna of VT Commercial |
$381.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.01
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cash Price |
$203.18
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$377.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$38.57
|
|
|
DRUG ASSAY LACOSAMIDE
|
Facility
|
IP
|
$207.58
|
|
|
Service Code
|
CPT 80235
|
| Hospital Charge Code |
3008023501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.63 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Aetna of VT Commercial |
$197.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.06
|
| Rate for Payer: Cash Price |
$103.79
|
| Rate for Payer: Cigna Commercial |
$166.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.06
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.44
|
| Rate for Payer: United Healthcare Commercial |
$197.20
|
|
|
DRUG ASSAY LACOSAMIDE
|
Professional
|
Both
|
$207.58
|
|
|
Service Code
|
CPT 80235
|
| Hospital Charge Code |
3008023501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.73 |
| Max. Negotiated Rate |
$195.13 |
| Rate for Payer: Aetna of VT Commercial |
$195.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.14
|
| Rate for Payer: Cash Price |
$103.79
|
| Rate for Payer: Cash Price |
$103.79
|
| Rate for Payer: Cigna Commercial |
$32.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.73
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare Commercial |
$41.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare VA CCN |
$27.11
|
|
|
DRUG ASSAY LACOSAMIDE
|
Facility
|
OP
|
$207.58
|
|
|
Service Code
|
CPT 80235
|
| Hospital Charge Code |
3008023501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$197.20 |
| Rate for Payer: Aetna of VT Commercial |
$197.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.03
|
| Rate for Payer: Cash Price |
$103.79
|
| Rate for Payer: Cash Price |
$103.79
|
| Rate for Payer: Cigna Commercial |
$166.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.41
|
| Rate for Payer: Multiplan Commercial |
$193.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.41
|
| Rate for Payer: United Healthcare Commercial |
$197.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare VA CCN |
$93.41
|
|
|
DRUG ASSAY METHOTREXATE
|
Professional
|
Both
|
$177.70
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
3008020401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$190.05 |
| Rate for Payer: Aetna of VT Commercial |
$167.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.36
|
| Rate for Payer: Cash Price |
$88.85
|
| Rate for Payer: Cash Price |
$88.85
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$165.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$38.57
|
|
|
DRUG ASSAY METHOTREXATE
|
Facility
|
OP
|
$177.70
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
3008020401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$190.05 |
| Rate for Payer: Aetna of VT Commercial |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.27
|
| Rate for Payer: Cash Price |
$88.85
|
| Rate for Payer: Cash Price |
$88.85
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.97
|
| Rate for Payer: Multiplan Commercial |
$165.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.97
|
| Rate for Payer: United Healthcare Commercial |
$168.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$79.97
|
|
|
DRUG ASSAY METHOTREXATE
|
Facility
|
IP
|
$177.70
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
3008020401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$168.81 |
| Rate for Payer: Aetna of VT Commercial |
$168.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.16
|
| Rate for Payer: Cash Price |
$88.85
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.16
|
| Rate for Payer: Multiplan Commercial |
$165.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.04
|
| Rate for Payer: United Healthcare Commercial |
$168.81
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
OP
|
$352.85
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
3008017901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$335.21 |
| Rate for Payer: Aetna of VT Commercial |
$335.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$156.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$212.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$299.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$285.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$158.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.52
|
| Rate for Payer: Cash Price |
$176.43
|
| Rate for Payer: Cash Price |
$176.43
|
| Rate for Payer: Cigna Commercial |
$282.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.78
|
| Rate for Payer: Multiplan Commercial |
$328.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$299.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$158.78
|
| Rate for Payer: United Healthcare Commercial |
$335.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare VA CCN |
$158.78
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
IP
|
$352.85
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
3008017901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$261.14 |
| Max. Negotiated Rate |
$335.21 |
| Rate for Payer: Aetna of VT Commercial |
$335.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$261.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$261.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$299.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$296.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$282.28
|
| Rate for Payer: Cash Price |
$176.43
|
| Rate for Payer: Cigna Commercial |
$282.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.28
|
| Rate for Payer: Multiplan Commercial |
$328.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$299.92
|
| Rate for Payer: United Healthcare Commercial |
$335.21
|
|
|
DRUG ASSAY VEDOLIZUMAB
|
Professional
|
Both
|
$337.67
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
3008028001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$317.41 |
| Rate for Payer: Aetna of VT Commercial |
$317.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.01
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cigna Commercial |
$46.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$314.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$59.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$38.57
|
|
|
DRUG ASSAY VEDOLIZUMAB
|
Facility
|
IP
|
$337.67
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
3008028001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$249.91 |
| Max. Negotiated Rate |
$320.79 |
| Rate for Payer: Aetna of VT Commercial |
$320.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$249.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$249.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.14
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cigna Commercial |
$270.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.14
|
| Rate for Payer: Multiplan Commercial |
$314.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.02
|
| Rate for Payer: United Healthcare Commercial |
$320.79
|
|
|
DRUG ASSAY VEDOLIZUMAB
|
Facility
|
OP
|
$337.67
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
3008028001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$320.79 |
| Rate for Payer: Aetna of VT Commercial |
$320.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$151.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.45
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cash Price |
$168.84
|
| Rate for Payer: Cigna Commercial |
$270.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.95
|
| Rate for Payer: Multiplan Commercial |
$314.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$151.95
|
| Rate for Payer: United Healthcare Commercial |
$320.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare VA CCN |
$151.95
|
|
|
DRUG SCREEN AMPHETAMINES 1/2
|
Facility
|
IP
|
$362.42
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
3008032401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$268.23 |
| Max. Negotiated Rate |
$344.30 |
| Rate for Payer: Aetna of VT Commercial |
$344.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$268.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$268.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$289.94
|
| Rate for Payer: Cash Price |
$181.21
|
| Rate for Payer: Cigna Commercial |
$289.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.94
|
| Rate for Payer: Multiplan Commercial |
$337.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$308.06
|
| Rate for Payer: United Healthcare Commercial |
$344.30
|
|
|
DRUG SCREEN AMPHETAMINES 1/2
|
Facility
|
OP
|
$362.42
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
3008032401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$344.30 |
| Rate for Payer: Aetna of VT Commercial |
$344.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$308.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$293.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$163.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$288.12
|
| Rate for Payer: Cash Price |
$181.21
|
| Rate for Payer: Cash Price |
$181.21
|
| Rate for Payer: Cigna Commercial |
$289.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$289.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$289.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$163.09
|
| Rate for Payer: Multiplan Commercial |
$337.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$308.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$163.09
|
| Rate for Payer: United Healthcare Commercial |
$344.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.09
|
| Rate for Payer: United Healthcare VA CCN |
$163.09
|
|
|
DRUG SCREEN AMPHETAMINES 1/2
|
Professional
|
Both
|
$362.42
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
3008032401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$340.67 |
| Rate for Payer: Aetna of VT Commercial |
$340.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Cash Price |
$181.21
|
| Rate for Payer: Cash Price |
$181.21
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.34
|
| Rate for Payer: Multiplan Commercial |
$337.05
|
| Rate for Payer: United Healthcare Commercial |
$308.06
|
| Rate for Payer: United Healthcare VA CCN |
$144.97
|
|
|
DRUG SCREENING BENZODIAZEPINES
|
Facility
|
IP
|
$81.17
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3008034601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna of VT Commercial |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.94
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cigna Commercial |
$64.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.94
|
| Rate for Payer: Multiplan Commercial |
$75.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.99
|
| Rate for Payer: United Healthcare Commercial |
$77.11
|
|
|
DRUG SCREENING BENZODIAZEPINES
|
Facility
|
OP
|
$81.17
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3008034601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$77.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.53
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cigna Commercial |
$64.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.53
|
| Rate for Payer: Multiplan Commercial |
$75.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.53
|
| Rate for Payer: United Healthcare Commercial |
$77.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.53
|
| Rate for Payer: United Healthcare VA CCN |
$36.53
|
|
