|
ANTIBODY RUBELLA
|
Facility
|
IP
|
$168.54
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
3008676201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.74 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Aetna of VT Commercial |
$160.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.83
|
| Rate for Payer: Cash Price |
$84.27
|
| Rate for Payer: Cigna Commercial |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.83
|
| Rate for Payer: Multiplan Commercial |
$156.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.26
|
| Rate for Payer: United Healthcare Commercial |
$160.11
|
|
|
ANTIBODY RUBEOLA
|
Facility
|
OP
|
$138.56
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3008676501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$131.63 |
| Rate for Payer: Aetna of VT Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.16
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.35
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.35
|
| Rate for Payer: United Healthcare Commercial |
$131.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare VA CCN |
$62.35
|
|
|
ANTIBODY RUBEOLA
|
Professional
|
Both
|
$138.56
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3008676501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$130.25 |
| Rate for Payer: Aetna of VT Commercial |
$130.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.03
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.70
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$19.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare VA CCN |
$12.88
|
|
|
ANTIBODY RUBEOLA
|
Facility
|
IP
|
$138.56
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
3008676501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$131.63 |
| Rate for Payer: Aetna of VT Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.85
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.85
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.78
|
| Rate for Payer: United Healthcare Commercial |
$131.63
|
|
|
ANTIBODY TOXOPLASMA
|
Facility
|
OP
|
$237.73
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
3008677701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$225.84 |
| Rate for Payer: Aetna of VT Commercial |
$225.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$192.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.00
|
| Rate for Payer: Cash Price |
$118.86
|
| Rate for Payer: Cash Price |
$118.86
|
| Rate for Payer: Cigna Commercial |
$190.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$106.98
|
| Rate for Payer: Multiplan Commercial |
$221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$106.98
|
| Rate for Payer: United Healthcare Commercial |
$225.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$106.98
|
|
|
ANTIBODY TOXOPLASMA
|
Professional
|
Both
|
$237.73
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
3008677701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$223.47 |
| Rate for Payer: Aetna of VT Commercial |
$223.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.61
|
| Rate for Payer: Cash Price |
$118.86
|
| Rate for Payer: Cash Price |
$118.86
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.19
|
| Rate for Payer: Multiplan Commercial |
$221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
ANTIBODY TOXOPLASMA
|
Facility
|
IP
|
$237.73
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
3008677701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.94 |
| Max. Negotiated Rate |
$225.84 |
| Rate for Payer: Aetna of VT Commercial |
$225.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$175.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$175.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.18
|
| Rate for Payer: Cash Price |
$118.86
|
| Rate for Payer: Cigna Commercial |
$190.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$190.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$190.18
|
| Rate for Payer: Multiplan Commercial |
$221.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$202.07
|
| Rate for Payer: United Healthcare Commercial |
$225.84
|
|
|
ANTIBODY TOXOPLASMA IGM
|
Professional
|
Both
|
$134.42
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
3008677801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna of VT Commercial |
$126.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.63
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.21
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.41
|
| Rate for Payer: United Healthcare Commercial |
$22.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: United Healthcare VA CCN |
$14.41
|
|
|
ANTIBODY TOXOPLASMA IGM
|
Facility
|
IP
|
$134.42
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
3008677801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.54
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
|
|
ANTIBODY TOXOPLASMA IGM
|
Facility
|
OP
|
$134.42
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
3008677801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.86
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.49
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.49
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: United Healthcare VA CCN |
$60.49
|
|
|
ANTIBODY TREPONEMA PALLIDUM
|
Facility
|
OP
|
$116.36
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3008678001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$110.54 |
| Rate for Payer: Aetna of VT Commercial |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.51
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cigna Commercial |
$93.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.36
|
| Rate for Payer: Multiplan Commercial |
$108.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.36
|
| Rate for Payer: United Healthcare Commercial |
$110.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare VA CCN |
$52.36
|
|
|
ANTIBODY TREPONEMA PALLIDUM
|
Professional
|
Both
|
$116.36
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3008678001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$109.38 |
| Rate for Payer: Aetna of VT Commercial |
$109.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.63
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$108.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$20.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare VA CCN |
$13.24
|
|
|
ANTIBODY TREPONEMA PALLIDUM
|
Facility
|
IP
|
$116.36
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
3008678001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$110.54 |
| Rate for Payer: Aetna of VT Commercial |
$110.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.09
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cigna Commercial |
$93.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.09
|
| Rate for Payer: Multiplan Commercial |
$108.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.91
|
| Rate for Payer: United Healthcare Commercial |
$110.54
|
|
|
ANTIBODY VARICELLA-ZOSTER
|
Facility
|
OP
|
$154.48
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3008678701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna of VT Commercial |
$146.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.81
|
| Rate for Payer: Cash Price |
$77.24
|
| Rate for Payer: Cash Price |
$77.24
|
| Rate for Payer: Cigna Commercial |
$123.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.52
|
| Rate for Payer: Multiplan Commercial |
$143.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.52
|
| Rate for Payer: United Healthcare Commercial |
$146.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare VA CCN |
$69.52
|
|
|
ANTIBODY VARICELLA-ZOSTER
|
Professional
|
Both
|
$154.48
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3008678701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$145.21 |
| Rate for Payer: Aetna of VT Commercial |
$145.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.03
|
| Rate for Payer: Cash Price |
$77.24
|
| Rate for Payer: Cash Price |
$77.24
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.70
|
| Rate for Payer: Multiplan Commercial |
$143.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$19.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare VA CCN |
$12.88
|
|
|
ANTIBODY VARICELLA-ZOSTER
|
Facility
|
IP
|
$154.48
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3008678701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.33 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna of VT Commercial |
$146.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.58
|
| Rate for Payer: Cash Price |
$77.24
|
| Rate for Payer: Cigna Commercial |
$123.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$123.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$123.58
|
| Rate for Payer: Multiplan Commercial |
$143.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.31
|
| Rate for Payer: United Healthcare Commercial |
$146.76
|
|
|
ANTIEPILEPTICS NOS 1-3
|
Facility
|
OP
|
$6.93
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3008033901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$6.58
|
| 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 |
$3.07
|
| 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 |
$4.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.51
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cigna Commercial |
$5.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.12
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.12
|
| Rate for Payer: United Healthcare VA CCN |
$3.12
|
|
|
ANTIEPILEPTICS NOS 1-3
|
Facility
|
IP
|
$6.93
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3008033901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: Aetna of VT Commercial |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5.54
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cigna Commercial |
$5.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.54
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.89
|
| Rate for Payer: United Healthcare Commercial |
$6.58
|
|
|
ANTIEPILEPTICS NOS 1-3
|
Professional
|
Both
|
$6.93
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3008033901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$144.83 |
| Rate for Payer: Aetna of VT Commercial |
$6.51
|
| 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 |
$3.46
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.83
|
| Rate for Payer: Multiplan Commercial |
$6.44
|
| Rate for Payer: United Healthcare Commercial |
$5.89
|
| Rate for Payer: United Healthcare VA CCN |
$2.77
|
|
|
ANTINUCLEAR ANTIBODIES (ANA)
|
Professional
|
Both
|
$212.62
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
3008603901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$199.86 |
| Rate for Payer: Aetna of VT Commercial |
$199.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.08
|
| Rate for Payer: Cash Price |
$106.31
|
| Rate for Payer: Cash Price |
$106.31
|
| Rate for Payer: Cigna Commercial |
$13.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$197.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.16
|
| Rate for Payer: United Healthcare VA CCN |
$11.16
|
|
|
ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
OP
|
$212.62
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
3008603901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$201.99 |
| Rate for Payer: Aetna of VT Commercial |
$201.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$94.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$128.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$169.03
|
| Rate for Payer: Cash Price |
$106.31
|
| Rate for Payer: Cash Price |
$106.31
|
| Rate for Payer: Cigna Commercial |
$170.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$197.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$95.68
|
| Rate for Payer: United Healthcare Commercial |
$201.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.16
|
| Rate for Payer: United Healthcare VA CCN |
$95.68
|
|
|
ANTINUCLEAR ANTIBODIES (ANA)
|
Facility
|
IP
|
$212.62
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
3008603901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$201.99 |
| Rate for Payer: Aetna of VT Commercial |
$201.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.10
|
| Rate for Payer: Cash Price |
$106.31
|
| Rate for Payer: Cigna Commercial |
$170.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$170.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$197.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$180.73
|
| Rate for Payer: United Healthcare Commercial |
$201.99
|
|
|
ANTINUCLEAR ANTIBODIES ANA
|
Facility
|
OP
|
$100.04
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3008603801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna of VT Commercial |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$60.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$79.53
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.02
|
| Rate for Payer: Multiplan Commercial |
$93.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.02
|
| Rate for Payer: United Healthcare Commercial |
$95.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare VA CCN |
$45.02
|
|
|
ANTINUCLEAR ANTIBODIES ANA
|
Facility
|
IP
|
$100.04
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3008603801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.04 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna of VT Commercial |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$80.03
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$80.03
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$80.03
|
| Rate for Payer: Multiplan Commercial |
$93.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.03
|
| Rate for Payer: United Healthcare Commercial |
$95.04
|
|
|
ANTINUCLEAR ANTIBODIES ANA
|
Professional
|
Both
|
$100.04
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
3008603801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$94.04 |
| Rate for Payer: Aetna of VT Commercial |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.67
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cash Price |
$50.02
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.92
|
| Rate for Payer: Multiplan Commercial |
$93.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare Commercial |
$18.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare VA CCN |
$12.09
|
|
