|
HERNIA REPAIR W/MESH
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
9824956801
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$577.28 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of VT Commercial |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$577.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$655.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$624.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$725.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$663.00
|
| Rate for Payer: United Healthcare Commercial |
$741.00
|
|
|
HETEROPHILE ANTIBODIES SCREEN
|
Facility
|
IP
|
$82.46
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
3008630801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna of VT Commercial |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.97
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cigna Commercial |
$65.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.97
|
| Rate for Payer: Multiplan Commercial |
$76.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.09
|
| Rate for Payer: United Healthcare Commercial |
$78.34
|
|
|
HETEROPHILE ANTIBODIES SCREEN
|
Facility
|
OP
|
$82.46
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
3008630801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna of VT Commercial |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.56
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cash Price |
$41.23
|
| Rate for Payer: Cigna Commercial |
$65.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.11
|
| Rate for Payer: Multiplan Commercial |
$76.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.11
|
| Rate for Payer: United Healthcare Commercial |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$37.11
|
|
|
HFE GENE
|
Facility
|
OP
|
$230.58
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
3108125601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$322.06 |
| Rate for Payer: Aetna of VT Commercial |
$219.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$322.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$322.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.31
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cigna Commercial |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.76
|
| Rate for Payer: Multiplan Commercial |
$214.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.76
|
| Rate for Payer: United Healthcare Commercial |
$219.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.36
|
| Rate for Payer: United Healthcare VA CCN |
$103.76
|
|
|
HFE GENE
|
Facility
|
IP
|
$230.58
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
3108125601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$170.65 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna of VT Commercial |
$219.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.46
|
| Rate for Payer: Cash Price |
$115.29
|
| Rate for Payer: Cigna Commercial |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.46
|
| Rate for Payer: Multiplan Commercial |
$214.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.99
|
| Rate for Payer: United Healthcare Commercial |
$219.05
|
|
|
HG A1C>EQUAL 7.0%<8.0% CAT II
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 3051F
|
| Hospital Charge Code |
3003051F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C>EQUAL 7.0%<8.0% CAT II
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 3051F
|
| Hospital Charge Code |
3003051F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| 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 |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C>EQUAL 7.0%<8.0% CAT II
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 3051F
|
| Hospital Charge Code |
3003051F01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
HG A1C>EQUAL 8.0%<EQUAL 9.0%
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 3052F
|
| Hospital Charge Code |
3003052F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C>EQUAL 8.0%<EQUAL 9.0%
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 3052F
|
| Hospital Charge Code |
3003052F01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
HG A1C>EQUAL 8.0%<EQUAL 9.0%
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 3052F
|
| Hospital Charge Code |
3003052F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| 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 |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C LEVEL LT 7.0% CAT II
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 3044F
|
| Hospital Charge Code |
3003044F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| 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 |
$0.00
|
| 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 |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C LEVEL LT 7.0% CAT II
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 3044F
|
| Hospital Charge Code |
3003044F01
|
|
Hospital Revenue Code
|
300
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
HG A1C LEVEL LT 7.0% CAT II
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 3044F
|
| Hospital Charge Code |
3003044F01
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
HHV-6 DNA AMP PROBE
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
3008753201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$865.74 |
| Rate for Payer: Aetna of VT Commercial |
$865.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.98
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$856.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
HHV-6 DNA AMP PROBE
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
3008753201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Aetna of VT Commercial |
$874.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$407.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$554.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$782.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$746.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$732.20
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$736.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$736.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$736.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$414.45
|
| Rate for Payer: Multiplan Commercial |
$856.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$782.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$414.45
|
| Rate for Payer: United Healthcare Commercial |
$874.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$414.45
|
|
|
HHV-6 DNA AMP PROBE
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
3008753201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$681.63 |
| Max. Negotiated Rate |
$874.95 |
| Rate for Payer: Aetna of VT Commercial |
$874.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$681.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$681.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$782.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$773.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$736.80
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$736.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$736.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$736.80
|
| Rate for Payer: Multiplan Commercial |
$856.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$782.85
|
| Rate for Payer: United Healthcare Commercial |
$874.95
|
|
|
HI ENRGY ESWT PLANTAR FASCIA
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
CPT 28890
|
| Hospital Charge Code |
9822889001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$213.93 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Aetna of VT Commercial |
$343.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$220.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$299.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$512.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$512.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$246.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$512.16
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$407.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$295.52
|
| Rate for Payer: Multiplan Commercial |
$339.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$303.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$213.93
|
| Rate for Payer: United Healthcare Commercial |
$329.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.93
|
| Rate for Payer: United Healthcare VA CCN |
$213.93
|
|
|
HI ENRGY ESWT PLANTAR FASCIA
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 28890
|
| Hospital Charge Code |
9822889001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$161.66 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Aetna of VT Commercial |
$346.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$161.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$219.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$310.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$295.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$290.18
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$292.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$292.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$292.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$164.25
|
| Rate for Payer: Multiplan Commercial |
$339.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$310.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$164.25
|
| Rate for Payer: United Healthcare Commercial |
$346.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.25
|
| Rate for Payer: United Healthcare VA CCN |
$164.25
|
|
|
HI ENRGY ESWT PLANTAR FASCIA
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 28890
|
| Hospital Charge Code |
9822889001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$270.14 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Aetna of VT Commercial |
$346.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$270.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$270.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$310.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$292.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$292.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$292.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$292.00
|
| Rate for Payer: Multiplan Commercial |
$339.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$310.25
|
| Rate for Payer: United Healthcare Commercial |
$346.75
|
|
|
HISTOCHEMICAL STAINS ADD-ON
|
Facility
|
OP
|
$238.85
|
|
|
Service Code
|
CPT 88314
|
| Hospital Charge Code |
3108831401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.19 |
| Max. Negotiated Rate |
$333.99 |
| Rate for Payer: Aetna of VT Commercial |
$226.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$333.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$105.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$333.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$143.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$189.89
|
| Rate for Payer: Cash Price |
$119.42
|
| Rate for Payer: Cash Price |
$119.42
|
| Rate for Payer: Cigna Commercial |
$191.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.48
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.48
|
| Rate for Payer: United Healthcare Commercial |
$226.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.19
|
| Rate for Payer: United Healthcare VA CCN |
$107.48
|
|
|
HISTOCHEMICAL STAINS ADD-ON
|
Facility
|
IP
|
$238.85
|
|
|
Service Code
|
CPT 88314
|
| Hospital Charge Code |
3108831401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$226.91 |
| Rate for Payer: Aetna of VT Commercial |
$226.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.08
|
| Rate for Payer: Cash Price |
$119.42
|
| Rate for Payer: Cigna Commercial |
$191.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.08
|
| Rate for Payer: Multiplan Commercial |
$222.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.02
|
| Rate for Payer: United Healthcare Commercial |
$226.91
|
|
|
HISTOPLASMA ANTIBODY
|
Facility
|
IP
|
$90.30
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
3008669801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna of VT Commercial |
$85.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$72.24
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna Commercial |
$72.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$83.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.75
|
| Rate for Payer: United Healthcare Commercial |
$85.78
|
|
|
HISTOPLASMA ANTIBODY
|
Facility
|
OP
|
$90.30
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
3008669801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna of VT Commercial |
$85.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$54.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$76.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.79
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna Commercial |
$72.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$72.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$72.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.63
|
| Rate for Payer: Multiplan Commercial |
$83.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$76.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.63
|
| Rate for Payer: United Healthcare Commercial |
$85.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare VA CCN |
$40.63
|
|
|
HISTOPLASMA ANTIBODY
|
Professional
|
Both
|
$90.30
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
3008669801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$84.88 |
| Rate for Payer: Aetna of VT Commercial |
$84.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.87
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cash Price |
$45.15
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$83.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare Commercial |
$21.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare VA CCN |
$13.79
|
|
