|
HIV-1 AG W/HIV-1&-2 AB AG IA
|
Facility
|
IP
|
$82.72
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
3008738901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.18
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
|
|
HIV-1 AG W/HIV-1&-2 AB AG IA
|
Professional
|
Both
|
$82.72
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
3008738901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$118.65 |
| Rate for Payer: Aetna of VT Commercial |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$33.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$41.16
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$23.74
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare Commercial |
$37.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare VA CCN |
$24.08
|
|
|
HIV-1 AG W/HIV-1&-2 AB AG IA
|
Facility
|
OP
|
$82.72
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
3008738901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$118.65 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.76
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.22
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.08
|
| Rate for Payer: United Healthcare VA CCN |
$37.22
|
|
|
HIV-1 QUANT&REVRSE TRNSCRPJ
|
Facility
|
OP
|
$601.79
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3008753601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$571.70 |
| Rate for Payer: Aetna of VT Commercial |
$571.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$419.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$419.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$362.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$511.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$487.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$270.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$478.42
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$481.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$481.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$481.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$270.81
|
| Rate for Payer: Multiplan Commercial |
$559.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$511.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.81
|
| Rate for Payer: United Healthcare Commercial |
$571.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare VA CCN |
$270.81
|
|
|
HIV-1 QUANT&REVRSE TRNSCRPJ
|
Professional
|
Both
|
$601.79
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3008753601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.91 |
| Max. Negotiated Rate |
$565.68 |
| Rate for Payer: Aetna of VT Commercial |
$565.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$419.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$419.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.08
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$103.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$85.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$85.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.91
|
| Rate for Payer: Multiplan Commercial |
$559.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$130.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare VA CCN |
$85.10
|
|
|
HIV-1 QUANT&REVRSE TRNSCRPJ
|
Facility
|
IP
|
$601.79
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
3008753601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$571.70 |
| Rate for Payer: Aetna of VT Commercial |
$571.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$445.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$445.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$511.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$505.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$481.43
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$481.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$481.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$481.43
|
| Rate for Payer: Multiplan Commercial |
$559.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$511.52
|
| Rate for Payer: United Healthcare Commercial |
$571.70
|
|
|
HLA II TYPING 1 LOCUS LR
|
Professional
|
Both
|
$466.54
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
3008137601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$602.24 |
| Rate for Payer: Aetna of VT Commercial |
$438.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$602.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$602.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$171.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$208.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$140.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.91
|
| Rate for Payer: Cash Price |
$233.27
|
| Rate for Payer: Cash Price |
$233.27
|
| Rate for Payer: Cigna Commercial |
$147.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.51
|
| Rate for Payer: Multiplan Commercial |
$433.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare Commercial |
$188.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare VA CCN |
$122.22
|
|
|
HLA II TYPING 1 LOCUS LR
|
Facility
|
OP
|
$466.54
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
3008137601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$602.24 |
| Rate for Payer: Aetna of VT Commercial |
$443.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$602.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$206.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$602.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$280.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$377.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$209.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$370.90
|
| Rate for Payer: Cash Price |
$233.27
|
| Rate for Payer: Cash Price |
$233.27
|
| Rate for Payer: Cigna Commercial |
$373.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.94
|
| Rate for Payer: Multiplan Commercial |
$433.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$209.94
|
| Rate for Payer: United Healthcare Commercial |
$443.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare VA CCN |
$209.94
|
|
|
HLA II TYPING 1 LOCUS LR
|
Facility
|
IP
|
$466.54
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
3008137601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$345.29 |
| Max. Negotiated Rate |
$443.21 |
| Rate for Payer: Aetna of VT Commercial |
$443.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$345.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$345.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$373.23
|
| Rate for Payer: Cash Price |
$233.27
|
| Rate for Payer: Cigna Commercial |
$373.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$373.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$373.23
|
| Rate for Payer: Multiplan Commercial |
$433.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.56
|
| Rate for Payer: United Healthcare Commercial |
$443.21
|
|
|
HLA I TYPING 1 ANTIGEN LR
|
Professional
|
Both
|
$273.60
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
3008137401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$366.26 |
| Rate for Payer: Aetna of VT Commercial |
$257.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$366.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$366.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.05
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$90.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.29
|
| Rate for Payer: Multiplan Commercial |
$254.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare Commercial |
$114.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare VA CCN |
$74.33
|
|
|
HLA I TYPING 1 ANTIGEN LR
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
3008137401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$366.26 |
| Rate for Payer: Aetna of VT Commercial |
$259.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$366.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$121.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$366.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$164.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$221.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$123.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.51
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$218.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.88
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.12
|
| Rate for Payer: Multiplan Commercial |
$254.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.12
|
| Rate for Payer: United Healthcare Commercial |
$259.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.33
|
| Rate for Payer: United Healthcare VA CCN |
$123.12
|
|
|
HLA I TYPING 1 ANTIGEN LR
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
3008137401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna of VT Commercial |
$259.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$202.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$202.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$232.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.88
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$218.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$218.88
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$218.88
|
| Rate for Payer: Multiplan Commercial |
$254.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$232.56
|
| Rate for Payer: United Healthcare Commercial |
$259.92
|
|
|
HLA TYPING A/B/C SINGLE ANTIGE
|
Facility
|
OP
|
$165.44
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
3008681201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$157.17 |
| Rate for Payer: Aetna of VT Commercial |
$157.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$73.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$134.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.52
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Commercial |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.45
|
| Rate for Payer: Multiplan Commercial |
$153.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.45
|
| Rate for Payer: United Healthcare Commercial |
$157.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare VA CCN |
$74.45
|
|
|
HLA TYPING A/B/C SINGLE ANTIGE
|
Professional
|
Both
|
$165.44
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
3008681201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$155.51 |
| Rate for Payer: Aetna of VT Commercial |
$155.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.10
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Commercial |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$153.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare Commercial |
$39.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare VA CCN |
$25.81
|
|
|
HLA TYPING A/B/C SINGLE ANTIGE
|
Facility
|
IP
|
$165.44
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
3008681201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.44 |
| Max. Negotiated Rate |
$157.17 |
| Rate for Payer: Aetna of VT Commercial |
$157.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$122.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$122.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$132.35
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cigna Commercial |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$132.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$132.35
|
| Rate for Payer: Multiplan Commercial |
$153.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.62
|
| Rate for Payer: United Healthcare Commercial |
$157.17
|
|
|
HOME/RES VST EST HIGH MDM 60
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
9839935001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$218.33 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
|
|
HOME/RES VST EST HIGH MDM 60
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
9839935001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$130.66 |
| Max. Negotiated Rate |
$280.25 |
| Rate for Payer: Aetna of VT Commercial |
$280.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$234.53
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$280.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.75
|
| Rate for Payer: United Healthcare VA CCN |
$132.75
|
|
|
HOME/RES VST EST HIGH MDM 60
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
9839935001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$173.94 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna of VT Commercial |
$277.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$179.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$243.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$290.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$200.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$290.21
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$190.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$282.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$282.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$173.95
|
| Rate for Payer: Multiplan Commercial |
$274.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$173.94
|
| Rate for Payer: United Healthcare Commercial |
$267.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$173.94
|
| Rate for Payer: United Healthcare VA CCN |
$173.94
|
|
|
HOME/RES VST EST LOW MDM 30
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
9839934801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$105.83 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna of VT Commercial |
$135.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.40
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.40
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.55
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
|
|
HOME/RES VST EST LOW MDM 30
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
9839934801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna of VT Commercial |
$135.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.69
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.35
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.35
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.35
|
| Rate for Payer: United Healthcare VA CCN |
$64.35
|
|
|
HOME/RES VST EST LOW MDM 30
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
9839934801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.66 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna of VT Commercial |
$134.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.17
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$78.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$117.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$117.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.66
|
| Rate for Payer: Multiplan Commercial |
$132.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.67
|
| Rate for Payer: United Healthcare Commercial |
$111.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.67
|
| Rate for Payer: United Healthcare VA CCN |
$72.67
|
|
|
HOME/RES VST EST MOD MDM 40
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
9839934901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$119.83 |
| Max. Negotiated Rate |
$234.06 |
| Rate for Payer: Aetna of VT Commercial |
$234.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$123.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$202.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$202.44
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$130.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.83
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.83
|
| Rate for Payer: United Healthcare Commercial |
$184.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.83
|
| Rate for Payer: United Healthcare VA CCN |
$119.83
|
|
|
HOME/RES VST EST MOD MDM 40
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
9839934901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna of VT Commercial |
$236.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.20
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
|
|
HOME/RES VST EST MOD MDM 40
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
9839934901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.28 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna of VT Commercial |
$236.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$211.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.96
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.05
|
| Rate for Payer: Multiplan Commercial |
$231.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$211.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare Commercial |
$236.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.05
|
| Rate for Payer: United Healthcare VA CCN |
$112.05
|
|
|
HOME/RES VST NEW LOW MDM 30
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
9839934201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$150.25 |
| Rate for Payer: Aetna of VT Commercial |
$144.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.25
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$80.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.46
|
| Rate for Payer: Multiplan Commercial |
$143.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.46
|
| Rate for Payer: United Healthcare Commercial |
$114.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.46
|
| Rate for Payer: United Healthcare VA CCN |
$74.46
|
|
