|
F5 GENE
|
Professional
|
Both
|
$403.26
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
3008124101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$379.06 |
| Rate for Payer: Aetna of VT Commercial |
$379.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$84.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.00
|
| Rate for Payer: Cash Price |
$201.63
|
| Rate for Payer: Cash Price |
$201.63
|
| Rate for Payer: Cigna Commercial |
$88.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$73.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$73.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.34
|
| Rate for Payer: Multiplan Commercial |
$375.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare Commercial |
$112.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare VA CCN |
$73.37
|
|
|
F5 GENE
|
Facility
|
OP
|
$403.26
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
3008124101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$383.10 |
| Rate for Payer: Aetna of VT Commercial |
$383.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$361.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$178.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$361.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$242.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$326.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$181.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$320.59
|
| Rate for Payer: Cash Price |
$201.63
|
| Rate for Payer: Cash Price |
$201.63
|
| Rate for Payer: Cigna Commercial |
$322.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$181.47
|
| Rate for Payer: Multiplan Commercial |
$375.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.47
|
| Rate for Payer: United Healthcare Commercial |
$383.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare VA CCN |
$181.47
|
|
|
F5 GENE
|
Facility
|
IP
|
$403.26
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
3008124101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.45 |
| Max. Negotiated Rate |
$383.10 |
| Rate for Payer: Aetna of VT Commercial |
$383.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$298.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$298.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$342.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$338.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$322.61
|
| Rate for Payer: Cash Price |
$201.63
|
| Rate for Payer: Cigna Commercial |
$322.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$322.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$322.61
|
| Rate for Payer: Multiplan Commercial |
$375.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.77
|
| Rate for Payer: United Healthcare Commercial |
$383.10
|
|
|
FACTOR INHIBITOR TEST
|
Facility
|
IP
|
$269.56
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
3008533501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Aetna of VT Commercial |
$256.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.65
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.65
|
| Rate for Payer: Multiplan Commercial |
$250.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.13
|
| Rate for Payer: United Healthcare Commercial |
$256.08
|
|
|
FACTOR INHIBITOR TEST
|
Professional
|
Both
|
$269.56
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
3008533501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$253.39 |
| Rate for Payer: Aetna of VT Commercial |
$253.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.99
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.69
|
| Rate for Payer: Multiplan Commercial |
$250.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$19.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare VA CCN |
$12.87
|
|
|
FACTOR INHIBITOR TEST
|
Facility
|
OP
|
$269.56
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
3008533501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Aetna of VT Commercial |
$256.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.30
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cash Price |
$134.78
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.30
|
| Rate for Payer: Multiplan Commercial |
$250.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.30
|
| Rate for Payer: United Healthcare Commercial |
$256.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare VA CCN |
$121.30
|
|
|
FAMOTIDINE 20 MG VIAL
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
636J130801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of VT Commercial |
$5.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.32
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.59
|
| Rate for Payer: United Healthcare Commercial |
$5.13
|
|
|
FAMOTIDINE 20 MG VIAL
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
636J130801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna of VT Commercial |
$5.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.29
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.43
|
| Rate for Payer: Multiplan Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.43
|
| Rate for Payer: United Healthcare Commercial |
$5.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.43
|
| Rate for Payer: United Healthcare VA CCN |
$2.43
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,660.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
9822604501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$455.44 |
| Max. Negotiated Rate |
$1,560.40 |
| Rate for Payer: Aetna of VT Commercial |
$1,560.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$469.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$637.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,076.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,076.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$523.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,076.16
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$859.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$754.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$754.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$455.44
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$646.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$455.44
|
| Rate for Payer: United Healthcare Commercial |
$700.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$455.44
|
| Rate for Payer: United Healthcare VA CCN |
$455.44
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
9822604501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,228.57 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,577.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,228.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,228.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,411.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,394.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,328.00
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,328.00
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,411.00
|
| Rate for Payer: United Healthcare Commercial |
$1,577.00
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
9822604501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$735.21 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,577.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$735.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,487.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$999.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,411.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,344.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$747.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,319.70
|
| Rate for Payer: Cash Price |
$830.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,328.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,328.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$747.00
|
| Rate for Payer: Multiplan Commercial |
$1,543.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,411.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$747.00
|
| Rate for Payer: United Healthcare Commercial |
$1,577.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.00
|
| Rate for Payer: United Healthcare VA CCN |
$747.00
|
|
|
FAT/LIPIDS FECES QUANTITATIVE
|
Facility
|
OP
|
$86.86
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
3008217001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$82.78 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.05
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.09
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.09
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare VA CCN |
$39.09
|
|
|
FAT/LIPIDS FECES QUANTITATIVE
|
Professional
|
Both
|
$86.86
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
3008217001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$82.78 |
| Rate for Payer: Aetna of VT Commercial |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.71
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$20.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$25.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare VA CCN |
$16.80
|
|
|
FAT/LIPIDS FECES QUANTITATIVE
|
Facility
|
IP
|
$86.86
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
3008217001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$82.52 |
| Rate for Payer: Aetna of VT Commercial |
$82.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.49
|
| Rate for Payer: Cash Price |
$43.43
|
| Rate for Payer: Cigna Commercial |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$82.52
|
|
|
FEMDISCUTBI-CT-GMK-LM-#5+ ST
|
Facility
|
OP
|
$103.40
|
|
| Hospital Charge Code |
2720055571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
FEMDISCUTBI-CT-GMK-LM-#5+ ST
|
Facility
|
IP
|
$103.40
|
|
| Hospital Charge Code |
2720055571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
FEMORAL HEAD 0 40 SIZE S
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.67 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$846.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$915.20
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
|
|
FEMORAL HEAD 0 40 SIZE S
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.68 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna of VT Commercial |
$1,086.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$506.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,024.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$688.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$972.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$926.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$909.48
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$915.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$915.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$514.80
|
| Rate for Payer: Multiplan Commercial |
$1,063.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$972.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$1,086.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$514.80
|
| Rate for Payer: United Healthcare VA CCN |
$514.80
|
|
|
FEMORAL TROCHLEAR 7.0X5MM XL
|
Facility
|
OP
|
$17,280.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780075661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,653.31 |
| Max. Negotiated Rate |
$16,416.00 |
| Rate for Payer: Aetna of VT Commercial |
$16,416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15,481.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7,653.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15,481.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10,402.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14,688.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13,996.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7,776.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13,737.60
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna Commercial |
$13,824.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13,824.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13,824.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$7,776.00
|
| Rate for Payer: Multiplan Commercial |
$16,070.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14,688.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7,776.00
|
| Rate for Payer: United Healthcare Commercial |
$16,416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,776.00
|
| Rate for Payer: United Healthcare VA CCN |
$7,776.00
|
|
|
FEMORAL TROCHLEAR 7.0X5MM XL
|
Facility
|
IP
|
$17,280.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780075661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,788.93 |
| Max. Negotiated Rate |
$16,416.00 |
| Rate for Payer: Aetna of VT Commercial |
$16,416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$12,788.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$12,788.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14,688.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14,515.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13,824.00
|
| Rate for Payer: Cash Price |
$8,640.00
|
| Rate for Payer: Cigna Commercial |
$13,824.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13,824.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13,824.00
|
| Rate for Payer: Multiplan Commercial |
$16,070.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14,688.00
|
| Rate for Payer: United Healthcare Commercial |
$16,416.00
|
|
|
FEMOR COMPONENT CEMENTED S3 RM
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.31 |
| Max. Negotiated Rate |
$1,961.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,961.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,528.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,528.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,755.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,734.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,652.00
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: Cigna Commercial |
$1,652.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,652.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,652.00
|
| Rate for Payer: Multiplan Commercial |
$1,920.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,755.25
|
| Rate for Payer: United Healthcare Commercial |
$1,961.75
|
|
|
FEMOR COMPONENT CEMENTED S3 RM
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2780074191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.59 |
| Max. Negotiated Rate |
$1,961.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,961.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,850.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$914.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,850.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,243.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,755.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,672.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$929.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,641.67
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: Cigna Commercial |
$1,652.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,652.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,652.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$929.25
|
| Rate for Payer: Multiplan Commercial |
$1,920.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,755.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$929.25
|
| Rate for Payer: United Healthcare Commercial |
$1,961.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$929.25
|
| Rate for Payer: United Healthcare VA CCN |
$929.25
|
|
|
FERN TEST
|
Facility
|
IP
|
$73.20
|
|
|
Service Code
|
CPT Q0114
|
| Hospital Charge Code |
300Q011401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$69.54 |
| Rate for Payer: Aetna of VT Commercial |
$69.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.56
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$58.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$68.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.22
|
| Rate for Payer: United Healthcare Commercial |
$69.54
|
|
|
FERN TEST
|
Professional
|
Both
|
$73.20
|
|
|
Service Code
|
CPT Q0114
|
| Hospital Charge Code |
300Q011401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna of VT Commercial |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.70
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$68.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$14.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.74
|
| Rate for Payer: United Healthcare VA CCN |
$9.74
|
|
|
FERN TEST
|
Facility
|
OP
|
$73.20
|
|
|
Service Code
|
CPT Q0114
|
| Hospital Charge Code |
300Q011401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$69.54 |
| Rate for Payer: Aetna of VT Commercial |
$69.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.19
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$58.56
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$32.94
|
| Rate for Payer: Multiplan Commercial |
$68.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.94
|
| Rate for Payer: United Healthcare Commercial |
$69.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.74
|
| Rate for Payer: United Healthcare VA CCN |
$32.94
|
|
