|
HEPARIN ASSAY
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
3008552001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$132.61 |
| Rate for Payer: Aetna of VT Commercial |
$132.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.97
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: Cigna Commercial |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.82
|
| Rate for Payer: Multiplan Commercial |
$129.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.82
|
| Rate for Payer: United Healthcare Commercial |
$132.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.09
|
| Rate for Payer: United Healthcare VA CCN |
$62.82
|
|
|
HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
3008552501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Aetna of VT Commercial |
$65.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.46
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cigna Commercial |
$54.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.82
|
| Rate for Payer: United Healthcare Commercial |
$65.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.84
|
| Rate for Payer: United Healthcare VA CCN |
$30.82
|
|
|
HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
3008552501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Aetna of VT Commercial |
$65.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.80
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cigna Commercial |
$54.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.23
|
| Rate for Payer: United Healthcare Commercial |
$65.08
|
|
|
HEPARIN NEUTRALIZATION
|
Professional
|
Both
|
$68.50
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
3008552501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$64.39 |
| Rate for Payer: Aetna of VT Commercial |
$64.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.24
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cigna Commercial |
$14.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.67
|
| Rate for Payer: Multiplan Commercial |
$63.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.84
|
| Rate for Payer: United Healthcare Commercial |
$18.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.84
|
| Rate for Payer: United Healthcare VA CCN |
$11.84
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$119.63
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
3008007601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$113.65 |
| Rate for Payer: Aetna of VT Commercial |
$113.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$72.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.11
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cigna Commercial |
$95.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.83
|
| Rate for Payer: Multiplan Commercial |
$111.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.83
|
| Rate for Payer: United Healthcare Commercial |
$113.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare VA CCN |
$53.83
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$119.63
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
3008007601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$113.65 |
| Rate for Payer: Aetna of VT Commercial |
$113.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.70
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cigna Commercial |
$95.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$111.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.69
|
| Rate for Payer: United Healthcare Commercial |
$113.65
|
|
|
HEPATITIS A ANTIBODY HAAB
|
Professional
|
Both
|
$139.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3008670801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$131.43 |
| Rate for Payer: Aetna of VT Commercial |
$131.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.18
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$130.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare Commercial |
$19.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare VA CCN |
$12.39
|
|
|
HEPATITIS A ANTIBODY HAAB
|
Facility
|
OP
|
$139.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3008670801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$132.83 |
| Rate for Payer: Aetna of VT Commercial |
$132.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$84.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.16
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna Commercial |
$111.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.92
|
| Rate for Payer: Multiplan Commercial |
$130.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.92
|
| Rate for Payer: United Healthcare Commercial |
$132.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare VA CCN |
$62.92
|
|
|
HEPATITIS A ANTIBODY HAAB
|
Facility
|
IP
|
$139.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
3008670801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$132.83 |
| Rate for Payer: Aetna of VT Commercial |
$132.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.86
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cigna Commercial |
$111.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$111.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$111.86
|
| Rate for Payer: Multiplan Commercial |
$130.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.85
|
| Rate for Payer: United Healthcare Commercial |
$132.83
|
|
|
HEPATITIS A IGM ANTIBODY
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
3008670901
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HEPATITIS A IGM ANTIBODY
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
3008670901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| 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 |
$55.48
|
| 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 |
$55.48
|
| 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: 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 |
$11.26
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
HEPATITIS A IGM ANTIBODY
|
Professional
|
Both
|
$103.40
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
3008670901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna of VT Commercial |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.25
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$13.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.10
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$17.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare VA CCN |
$11.26
|
|
|
HEPATITIS B CORE ANTIBODY HBCA
|
Professional
|
Both
|
$125.74
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
3008670401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna of VT Commercial |
$118.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.59
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.88
|
| Rate for Payer: Multiplan Commercial |
$116.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$12.05
|
|
|
HEPATITIS B CORE ANTIBODY HBCA
|
Facility
|
OP
|
$125.74
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
3008670401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Aetna of VT Commercial |
$119.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.96
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cigna Commercial |
$100.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.58
|
| Rate for Payer: Multiplan Commercial |
$116.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.58
|
| Rate for Payer: United Healthcare Commercial |
$119.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare VA CCN |
$56.58
|
|
|
HEPATITIS B CORE ANTIBODY HBCA
|
Facility
|
IP
|
$125.74
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
3008670401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Aetna of VT Commercial |
$119.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.59
|
| Rate for Payer: Cash Price |
$62.87
|
| Rate for Payer: Cigna Commercial |
$100.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.59
|
| Rate for Payer: Multiplan Commercial |
$116.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.88
|
| Rate for Payer: United Healthcare Commercial |
$119.45
|
|
|
HEPATITIS BE AG IA
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
3008735001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$83.17 |
| Rate for Payer: Aetna of VT Commercial |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.60
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.40
|
| Rate for Payer: United Healthcare Commercial |
$83.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare VA CCN |
$39.40
|
|
|
HEPATITIS BE AG IA
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
3008735001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$83.17 |
| Rate for Payer: Aetna of VT Commercial |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.04
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.04
|
| Rate for Payer: Multiplan Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$83.17
|
|
|
HEPATITIS BE ANTIBODY HBEAB
|
Facility
|
IP
|
$206.37
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
3008670701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.73 |
| Max. Negotiated Rate |
$196.05 |
| Rate for Payer: Aetna of VT Commercial |
$196.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$173.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.10
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cigna Commercial |
$165.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.10
|
| Rate for Payer: Multiplan Commercial |
$191.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.41
|
| Rate for Payer: United Healthcare Commercial |
$196.05
|
|
|
HEPATITIS BE ANTIBODY HBEAB
|
Facility
|
OP
|
$206.37
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
3008670701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$196.05 |
| Rate for Payer: Aetna of VT Commercial |
$196.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$91.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$124.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$175.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$167.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.06
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cigna Commercial |
$165.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$165.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$165.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.87
|
| Rate for Payer: Multiplan Commercial |
$191.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.87
|
| Rate for Payer: United Healthcare Commercial |
$196.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare VA CCN |
$92.87
|
|
|
HEPATITIS BE ANTIBODY HBEAB
|
Professional
|
Both
|
$206.37
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
3008670701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$193.99 |
| Rate for Payer: Aetna of VT Commercial |
$193.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.77
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.41
|
| Rate for Payer: Multiplan Commercial |
$191.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$17.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare VA CCN |
$11.57
|
|
|
HEPATITIS B SURFACE AG IA
|
Professional
|
Both
|
$147.08
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
3008734001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$138.26 |
| Rate for Payer: Aetna of VT Commercial |
$138.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.66
|
| Rate for Payer: Cash Price |
$73.54
|
| Rate for Payer: Cash Price |
$73.54
|
| Rate for Payer: Cigna Commercial |
$12.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$136.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare Commercial |
$15.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare VA CCN |
$10.33
|
|
|
HEPATITIS B SURFACE AG IA
|
Facility
|
IP
|
$147.08
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
3008734001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.85 |
| Max. Negotiated Rate |
$139.73 |
| Rate for Payer: Aetna of VT Commercial |
$139.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.66
|
| Rate for Payer: Cash Price |
$73.54
|
| Rate for Payer: Cigna Commercial |
$117.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.66
|
| Rate for Payer: Multiplan Commercial |
$136.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.02
|
| Rate for Payer: United Healthcare Commercial |
$139.73
|
|
|
HEPATITIS B SURFACE AG IA
|
Facility
|
OP
|
$147.08
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
3008734001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$139.73 |
| Rate for Payer: Aetna of VT Commercial |
$139.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$116.93
|
| Rate for Payer: Cash Price |
$73.54
|
| Rate for Payer: Cash Price |
$73.54
|
| Rate for Payer: Cigna Commercial |
$117.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.19
|
| Rate for Payer: Multiplan Commercial |
$136.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.19
|
| Rate for Payer: United Healthcare Commercial |
$139.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare VA CCN |
$66.19
|
|
|
HEPATITIS B SURF ANTIBODY HBSA
|
Professional
|
Both
|
$155.10
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
3008670601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$145.79 |
| Rate for Payer: Aetna of VT Commercial |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$12.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.36
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna Commercial |
$13.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$144.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$10.74
|
|
|
HEPATITIS B SURF ANTIBODY HBSA
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
3008670601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$147.34 |
| Rate for Payer: Aetna of VT Commercial |
$147.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$131.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$125.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$123.30
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna Commercial |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.80
|
| Rate for Payer: Multiplan Commercial |
$144.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$131.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$69.80
|
| Rate for Payer: United Healthcare Commercial |
$147.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare VA CCN |
$69.80
|
|
