|
DRUG SCREENING SEDATIVE HYPNOT
|
Professional
|
Both
|
$14.55
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
3008036801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna of VT Commercial |
$13.68
|
| 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 |
$7.28
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$13.53
|
| Rate for Payer: United Healthcare Commercial |
$12.37
|
| Rate for Payer: United Healthcare VA CCN |
$5.82
|
|
|
DRUG SCREENING SEDATIVE HYPNOT
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
3008036801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$13.82
|
| 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 |
$6.44
|
| 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 |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.57
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna Commercial |
$11.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.55
|
| Rate for Payer: Multiplan Commercial |
$13.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.55
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.55
|
| Rate for Payer: United Healthcare VA CCN |
$6.55
|
|
|
DRUG SCREENING SEDATIVE HYPNOT
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
3008036801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna of VT Commercial |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.64
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna Commercial |
$11.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.64
|
| Rate for Payer: Multiplan Commercial |
$13.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.37
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
|
|
DRUG SCREENING TRAMADOL
|
Facility
|
IP
|
$53.77
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
3008037301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna of VT Commercial |
$51.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.02
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cigna Commercial |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.02
|
| Rate for Payer: Multiplan Commercial |
$50.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.70
|
| Rate for Payer: United Healthcare Commercial |
$51.08
|
|
|
DRUG SCREENING TRAMADOL
|
Professional
|
Both
|
$53.77
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
3008037301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna of VT Commercial |
$50.54
|
| 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 |
$26.89
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$50.01
|
| Rate for Payer: United Healthcare Commercial |
$45.70
|
| Rate for Payer: United Healthcare VA CCN |
$21.51
|
|
|
DRUG SCREENING TRAMADOL
|
Facility
|
OP
|
$53.77
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
3008037301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$51.08
|
| 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 |
$23.81
|
| 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 |
$32.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.75
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cigna Commercial |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$50.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.20
|
| Rate for Payer: United Healthcare Commercial |
$51.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.20
|
| Rate for Payer: United Healthcare VA CCN |
$24.20
|
|
|
DRUG SCREEN QUAN LAMOTRIGINE
|
Facility
|
OP
|
$225.28
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
3008017501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$214.02 |
| Rate for Payer: Aetna of VT Commercial |
$214.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.10
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cigna Commercial |
$180.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.38
|
| Rate for Payer: Multiplan Commercial |
$209.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.38
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$101.38
|
|
|
DRUG SCREEN QUAN LAMOTRIGINE
|
Professional
|
Both
|
$225.28
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
3008017501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$211.76 |
| Rate for Payer: Aetna of VT Commercial |
$211.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.65
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.06
|
| Rate for Payer: Multiplan Commercial |
$209.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$20.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$13.25
|
|
|
DRUG SCREEN QUAN LAMOTRIGINE
|
Facility
|
IP
|
$225.28
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
3008017501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.73 |
| Max. Negotiated Rate |
$214.02 |
| Rate for Payer: Aetna of VT Commercial |
$214.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.22
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cigna Commercial |
$180.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.22
|
| Rate for Payer: Multiplan Commercial |
$209.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.49
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
|
|
DRUG SCREEN QUANT GABAPENTIN
|
Facility
|
OP
|
$348.49
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
3008017101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$331.07 |
| Rate for Payer: Aetna of VT Commercial |
$331.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$282.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$277.05
|
| Rate for Payer: Cash Price |
$174.24
|
| Rate for Payer: Cash Price |
$174.24
|
| Rate for Payer: Cigna Commercial |
$278.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.82
|
| Rate for Payer: Multiplan Commercial |
$324.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.82
|
| Rate for Payer: United Healthcare Commercial |
$331.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.67
|
| Rate for Payer: United Healthcare VA CCN |
$156.82
|
|
|
DRUG SCREEN QUANT GABAPENTIN
|
Professional
|
Both
|
$348.49
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
3008017101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$327.58 |
| Rate for Payer: Aetna of VT Commercial |
$327.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$106.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$106.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.11
|
| Rate for Payer: Cash Price |
$174.24
|
| Rate for Payer: Cash Price |
$174.24
|
| Rate for Payer: Cigna Commercial |
$26.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.37
|
| Rate for Payer: Multiplan Commercial |
$324.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.67
|
| Rate for Payer: United Healthcare Commercial |
$33.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.67
|
| Rate for Payer: United Healthcare VA CCN |
$21.67
|
|
|
DRUG SCREEN QUANT GABAPENTIN
|
Facility
|
IP
|
$348.49
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
3008017101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.92 |
| Max. Negotiated Rate |
$331.07 |
| Rate for Payer: Aetna of VT Commercial |
$331.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$296.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.79
|
| Rate for Payer: Cash Price |
$174.24
|
| Rate for Payer: Cigna Commercial |
$278.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.79
|
| Rate for Payer: Multiplan Commercial |
$324.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$296.22
|
| Rate for Payer: United Healthcare Commercial |
$331.07
|
|
|
DRUG SCREEN QUANTITATIVE LITHI
|
Facility
|
IP
|
$100.58
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
3008017801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of VT Commercial |
$95.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.46
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.49
|
| Rate for Payer: United Healthcare Commercial |
$95.55
|
|
|
DRUG SCREEN QUANTITATIVE LITHI
|
Professional
|
Both
|
$100.58
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
3008017801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna of VT Commercial |
$94.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.30
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.52
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.61
|
| Rate for Payer: United Healthcare Commercial |
$10.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: United Healthcare VA CCN |
$6.61
|
|
|
DRUG SCREEN QUANTITATIVE LITHI
|
Facility
|
OP
|
$100.58
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
3008017801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Aetna of VT Commercial |
$95.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.96
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cash Price |
$50.29
|
| Rate for Payer: Cigna Commercial |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.26
|
| Rate for Payer: Multiplan Commercial |
$93.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.26
|
| Rate for Payer: United Healthcare Commercial |
$95.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: United Healthcare VA CCN |
$45.26
|
|
|
DRUG SCREEN QUANT OXCARBAZEPIN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
3008018301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Aetna of VT Commercial |
$147.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$124.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$144.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.75
|
| Rate for Payer: United Healthcare Commercial |
$147.25
|
|
|
DRUG SCREEN QUANT OXCARBAZEPIN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
3008018301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Aetna of VT Commercial |
$147.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.22
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$124.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$144.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.75
|
| Rate for Payer: United Healthcare Commercial |
$147.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$69.75
|
|
|
DRUG SCREEN QUANT OXCARBAZEPIN
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
3008018301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$145.70 |
| Rate for Payer: Aetna of VT Commercial |
$145.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.65
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.06
|
| Rate for Payer: Multiplan Commercial |
$144.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$20.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$13.25
|
|
|
DRUG SCREEN QUANT PREGALABLIN
|
Facility
|
OP
|
$250.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$237.72 |
| Rate for Payer: Aetna of VT Commercial |
$237.72
|
| 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 |
$110.83
|
| 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 |
$150.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.93
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cigna Commercial |
$200.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.60
|
| Rate for Payer: Multiplan Commercial |
$232.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.60
|
| Rate for Payer: United Healthcare Commercial |
$237.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare VA CCN |
$112.60
|
|
|
DRUG SCREEN QUANT PREGALABLIN
|
Facility
|
IP
|
$250.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$237.72 |
| Rate for Payer: Aetna of VT Commercial |
$237.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.18
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cigna Commercial |
$200.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.18
|
| Rate for Payer: Multiplan Commercial |
$232.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.70
|
| Rate for Payer: United Healthcare Commercial |
$237.72
|
|
|
DRUG SCREEN QUANT PREGALABLIN
|
Professional
|
Both
|
$250.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3008029902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$235.22 |
| Rate for Payer: Aetna of VT Commercial |
$235.22
|
| 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 |
$19.20
|
| 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 |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.86
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$232.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$28.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare VA CCN |
$18.64
|
|
|
DRUG SCREEN QUANT PRIMIDONE
|
Facility
|
OP
|
$107.36
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
3008018801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$101.99 |
| Rate for Payer: Aetna of VT Commercial |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$47.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$48.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.35
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cigna Commercial |
$85.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.89
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.31
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.31
|
| Rate for Payer: United Healthcare Commercial |
$101.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.59
|
| Rate for Payer: United Healthcare VA CCN |
$48.31
|
|
|
DRUG SCREEN QUANT PRIMIDONE
|
Facility
|
IP
|
$107.36
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
3008018801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$101.99 |
| Rate for Payer: Aetna of VT Commercial |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.89
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cigna Commercial |
$85.89
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.89
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.89
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.26
|
| Rate for Payer: United Healthcare Commercial |
$101.99
|
|
|
DRUG SCREEN QUANT PRIMIDONE
|
Professional
|
Both
|
$107.36
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
3008018801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$100.92 |
| Rate for Payer: Aetna of VT Commercial |
$100.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.36
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cigna Commercial |
$20.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.36
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.59
|
| Rate for Payer: United Healthcare Commercial |
$25.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.59
|
| Rate for Payer: United Healthcare VA CCN |
$16.59
|
|
|
DRUG SCREEN QUANT ZONISAMIDE
|
Facility
|
IP
|
$212.29
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
3008020301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.12 |
| Max. Negotiated Rate |
$201.68 |
| Rate for Payer: Aetna of VT Commercial |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.83
|
| Rate for Payer: Cash Price |
$106.14
|
| Rate for Payer: Cigna Commercial |
$169.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$169.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$169.83
|
| Rate for Payer: Multiplan Commercial |
$197.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.45
|
| Rate for Payer: United Healthcare Commercial |
$201.68
|
|
