|
DRUG SCREENING BENZODIAZEPINES
|
Professional
|
Both
|
$81.17
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3008034601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$129.58 |
| Rate for Payer: Aetna of VT Commercial |
$76.30
|
| 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 |
$40.58
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.58
|
| Rate for Payer: Multiplan Commercial |
$75.49
|
| Rate for Payer: United Healthcare Commercial |
$68.99
|
| Rate for Payer: United Healthcare VA CCN |
$32.47
|
|
|
DRUG SCREENING BUPRENORPHINE
|
Facility
|
IP
|
$125.11
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
3008034801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.59 |
| Max. Negotiated Rate |
$118.85 |
| Rate for Payer: Aetna of VT Commercial |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.09
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cigna Commercial |
$100.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.09
|
| Rate for Payer: Multiplan Commercial |
$116.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.34
|
| Rate for Payer: United Healthcare Commercial |
$118.85
|
|
|
DRUG SCREENING BUPRENORPHINE
|
Facility
|
OP
|
$125.11
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
3008034801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.41 |
| Max. Negotiated Rate |
$118.85 |
| Rate for Payer: Aetna of VT Commercial |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.46
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cigna Commercial |
$100.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.30
|
| Rate for Payer: Multiplan Commercial |
$116.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.30
|
| Rate for Payer: United Healthcare Commercial |
$118.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.30
|
| Rate for Payer: United Healthcare VA CCN |
$56.30
|
|
|
DRUG SCREENING BUPRENORPHINE
|
Professional
|
Both
|
$125.11
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
3008034801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna of VT Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.09
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$116.35
|
| Rate for Payer: United Healthcare Commercial |
$106.34
|
| Rate for Payer: United Healthcare VA CCN |
$50.04
|
|
|
DRUG SCREENING COCAINE
|
Facility
|
OP
|
$57.90
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3008035301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$55.01
|
| 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 |
$25.64
|
| 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 |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.03
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.05
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.05
|
| Rate for Payer: United Healthcare VA CCN |
$26.05
|
|
|
DRUG SCREENING COCAINE
|
Professional
|
Both
|
$57.90
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3008035301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$54.43
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.87
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: United Healthcare Commercial |
$49.22
|
| Rate for Payer: United Healthcare VA CCN |
$23.16
|
|
|
DRUG SCREENING COCAINE
|
Facility
|
IP
|
$57.90
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
3008035301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$55.01 |
| Rate for Payer: Aetna of VT Commercial |
$55.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$49.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$46.32
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$53.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.22
|
| Rate for Payer: United Healthcare Commercial |
$55.01
|
|
|
DRUG SCREENING FENTANYL
|
Facility
|
IP
|
$116.84
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
3008035401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.47
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
|
|
DRUG SCREENING FENTANYL
|
Facility
|
OP
|
$116.84
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
3008035401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| 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 |
$51.75
|
| 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 |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.89
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.58
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.58
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.58
|
| Rate for Payer: United Healthcare VA CCN |
$52.58
|
|
|
DRUG SCREENING FENTANYL
|
Professional
|
Both
|
$116.84
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
3008035401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna of VT Commercial |
$109.83
|
| 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 |
$58.42
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: United Healthcare Commercial |
$99.31
|
| Rate for Payer: United Healthcare VA CCN |
$46.74
|
|
|
DRUG SCREENING METHADONE
|
Facility
|
IP
|
$224.12
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3008035801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.87 |
| Max. Negotiated Rate |
$212.91 |
| Rate for Payer: Aetna of VT Commercial |
$212.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.30
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cigna Commercial |
$179.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$208.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.50
|
| Rate for Payer: United Healthcare Commercial |
$212.91
|
|
|
DRUG SCREENING METHADONE
|
Professional
|
Both
|
$224.12
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3008035801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$210.67 |
| Rate for Payer: Aetna of VT Commercial |
$210.67
|
| 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: Blue Cross Blue Shield of Vermont Commercial |
$37.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.66
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$208.43
|
| Rate for Payer: United Healthcare Commercial |
$190.50
|
| Rate for Payer: United Healthcare VA CCN |
$89.65
|
|
|
DRUG SCREENING METHADONE
|
Facility
|
OP
|
$224.12
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3008035801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$212.91 |
| Rate for Payer: Aetna of VT Commercial |
$212.91
|
| 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 |
$99.26
|
| 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 |
$134.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$178.18
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cash Price |
$112.06
|
| Rate for Payer: Cigna Commercial |
$179.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.85
|
| Rate for Payer: Multiplan Commercial |
$208.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.85
|
| Rate for Payer: United Healthcare Commercial |
$212.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.85
|
| Rate for Payer: United Healthcare VA CCN |
$100.85
|
|
|
DRUG SCREENING METHYLPHENIDATE
|
Professional
|
Both
|
$142.69
|
|
|
Service Code
|
CPT 80360
|
| Hospital Charge Code |
3008036001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$266.78 |
| Rate for Payer: Aetna of VT Commercial |
$134.13
|
| 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 |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$266.78
|
| Rate for Payer: Multiplan Commercial |
$132.70
|
| Rate for Payer: United Healthcare Commercial |
$121.29
|
| Rate for Payer: United Healthcare VA CCN |
$57.08
|
|
|
DRUG SCREENING METHYLPHENIDATE
|
Facility
|
OP
|
$142.69
|
|
|
Service Code
|
CPT 80360
|
| Hospital Charge Code |
3008036001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$135.56 |
| Rate for Payer: Aetna of VT Commercial |
$135.56
|
| 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 |
$63.20
|
| 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 |
$85.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.44
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna Commercial |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.21
|
| Rate for Payer: Multiplan Commercial |
$132.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.21
|
| Rate for Payer: United Healthcare Commercial |
$135.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.21
|
| Rate for Payer: United Healthcare VA CCN |
$64.21
|
|
|
DRUG SCREENING METHYLPHENIDATE
|
Facility
|
IP
|
$142.69
|
|
|
Service Code
|
CPT 80360
|
| Hospital Charge Code |
3008036001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$135.56 |
| Rate for Payer: Aetna of VT Commercial |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.15
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna Commercial |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.15
|
| Rate for Payer: Multiplan Commercial |
$132.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.29
|
| Rate for Payer: United Healthcare Commercial |
$135.56
|
|
|
DRUG SCREENING OPIATES 1 OR MO
|
Facility
|
IP
|
$81.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
3008036101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna of VT Commercial |
$77.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.86
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cigna Commercial |
$64.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.86
|
| Rate for Payer: Multiplan Commercial |
$75.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.91
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
|
|
DRUG SCREENING OPIATES 1 OR MO
|
Professional
|
Both
|
$81.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
3008036101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$142.58 |
| Rate for Payer: Aetna of VT Commercial |
$76.21
|
| 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 |
$40.53
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.58
|
| Rate for Payer: Multiplan Commercial |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$68.91
|
| Rate for Payer: United Healthcare VA CCN |
$32.43
|
|
|
DRUG SCREENING OPIATES 1 OR MO
|
Facility
|
OP
|
$81.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
3008036101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$77.02
|
| 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 |
$35.91
|
| 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 |
$48.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.45
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cigna Commercial |
$64.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$75.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.48
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.48
|
| Rate for Payer: United Healthcare VA CCN |
$36.48
|
|
|
DRUG SCREENING OXYCODONE
|
Facility
|
OP
|
$26.88
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
3008036501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$25.54
|
| 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 |
$11.91
|
| 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 |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.37
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$21.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.10
|
| Rate for Payer: Multiplan Commercial |
$25.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.10
|
| Rate for Payer: United Healthcare Commercial |
$25.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.10
|
| Rate for Payer: United Healthcare VA CCN |
$12.10
|
|
|
DRUG SCREENING OXYCODONE
|
Facility
|
IP
|
$26.88
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
3008036501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$25.54 |
| Rate for Payer: Aetna of VT Commercial |
$25.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.50
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$21.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.50
|
| Rate for Payer: Multiplan Commercial |
$25.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.85
|
| Rate for Payer: United Healthcare Commercial |
$25.54
|
|
|
DRUG SCREENING OXYCODONE
|
Professional
|
Both
|
$26.88
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
3008036501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna of VT Commercial |
$25.27
|
| 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 |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$25.00
|
| Rate for Payer: United Healthcare Commercial |
$22.85
|
| Rate for Payer: United Healthcare VA CCN |
$10.75
|
|
|
DRUG SCREENING PREGABALIN
|
Facility
|
OP
|
$206.80
|
|
|
Service Code
|
CPT 80366
|
| Hospital Charge Code |
3008036601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| 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 |
$91.59
|
| 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 |
$124.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.41
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.06
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.06
|
| Rate for Payer: United Healthcare VA CCN |
$93.06
|
|
|
DRUG SCREENING PREGABALIN
|
Professional
|
Both
|
$206.80
|
|
|
Service Code
|
CPT 80366
|
| Hospital Charge Code |
3008036601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$384.32 |
| Rate for Payer: Aetna of VT Commercial |
$194.39
|
| 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 |
$103.40
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.32
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: United Healthcare Commercial |
$175.78
|
| Rate for Payer: United Healthcare VA CCN |
$82.72
|
|
|
DRUG SCREENING PREGABALIN
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
CPT 80366
|
| Hospital Charge Code |
3008036601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.05 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna of VT Commercial |
$196.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.44
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cigna Commercial |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.44
|
| Rate for Payer: Multiplan Commercial |
$192.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.78
|
| Rate for Payer: United Healthcare Commercial |
$196.46
|
|
