|
HPV SEP HI-RSK TYP&POOL RSLT
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
3008762601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$81.00
|
|
|
HPV SEP HI-RSK TYP&POOL RSLT
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
3008762601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of VT Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
HPV SEP HI-RSK TYP&POOL RSLT
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
3008762601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna of VT Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.73
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$83.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$69.22
|
| Rate for Payer: Multiplan Commercial |
$167.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Commercial |
$107.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare VA CCN |
$70.20
|
|
|
HPV TYPES 16 & 18 ONLY
|
Professional
|
Both
|
$128.40
|
|
|
Service Code
|
CPT 87625
|
| Hospital Charge Code |
3008762501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$199.81 |
| Rate for Payer: Aetna of VT Commercial |
$120.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.63
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$49.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.98
|
| Rate for Payer: Multiplan Commercial |
$119.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.55
|
| Rate for Payer: United Healthcare Commercial |
$62.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.55
|
| Rate for Payer: United Healthcare VA CCN |
$40.55
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
CPT 87625
|
| Hospital Charge Code |
3008762501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$199.81 |
| Rate for Payer: Aetna of VT Commercial |
$121.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.08
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$102.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$102.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$102.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.78
|
| Rate for Payer: Multiplan Commercial |
$119.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.78
|
| Rate for Payer: United Healthcare Commercial |
$121.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.55
|
| Rate for Payer: United Healthcare VA CCN |
$57.78
|
|
|
HPV TYPES 16 & 18 ONLY
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
CPT 87625
|
| Hospital Charge Code |
3008762501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$121.98 |
| Rate for Payer: Aetna of VT Commercial |
$121.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.72
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$102.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$102.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$102.72
|
| Rate for Payer: Multiplan Commercial |
$119.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.14
|
| Rate for Payer: United Healthcare Commercial |
$121.98
|
|
|
H PYLORI (C-13) BREATH
|
Facility
|
OP
|
$287.45
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
3008301301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna of VT Commercial |
$273.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$232.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.52
|
| Rate for Payer: Cash Price |
$143.72
|
| Rate for Payer: Cash Price |
$143.72
|
| Rate for Payer: Cigna Commercial |
$229.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$129.35
|
| Rate for Payer: Multiplan Commercial |
$267.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$129.35
|
| Rate for Payer: United Healthcare Commercial |
$273.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: United Healthcare VA CCN |
$129.35
|
|
|
H PYLORI (C-13) BREATH
|
Professional
|
Both
|
$287.45
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
3008301301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.42 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna of VT Commercial |
$270.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.14
|
| Rate for Payer: Cash Price |
$143.72
|
| Rate for Payer: Cash Price |
$143.72
|
| Rate for Payer: Cigna Commercial |
$81.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.42
|
| Rate for Payer: Multiplan Commercial |
$267.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.36
|
| Rate for Payer: United Healthcare Commercial |
$103.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: United Healthcare VA CCN |
$67.36
|
|
|
H PYLORI (C-13) BREATH
|
Facility
|
IP
|
$287.45
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
3008301301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.74 |
| Max. Negotiated Rate |
$273.08 |
| Rate for Payer: Aetna of VT Commercial |
$273.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$244.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.96
|
| Rate for Payer: Cash Price |
$143.72
|
| Rate for Payer: Cigna Commercial |
$229.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.96
|
| Rate for Payer: Multiplan Commercial |
$267.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$244.33
|
| Rate for Payer: United Healthcare Commercial |
$273.08
|
|
|
HSV DNA AMP PROBE
|
Facility
|
IP
|
$135.89
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
3008752901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.57 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna of VT Commercial |
$129.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$100.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$100.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.71
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cigna Commercial |
$108.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.71
|
| Rate for Payer: Multiplan Commercial |
$126.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.51
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
|
|
HSV DNA AMP PROBE
|
Facility
|
OP
|
$135.89
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
3008752901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$129.10
|
| 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 |
$60.19
|
| 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 |
$81.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$108.03
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cigna Commercial |
$108.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.15
|
| Rate for Payer: Multiplan Commercial |
$126.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.15
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$61.15
|
|
|
HSV DNA AMP PROBE
|
Professional
|
Both
|
$135.89
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
3008752901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$127.74
|
| 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 |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.07
|
| 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 |
$51.07
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Cash Price |
$67.94
|
| 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 |
$126.38
|
| 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
|
|
|
HTLV/HIV CONFIRMJ ANTIBODY
|
Professional
|
Both
|
$348.04
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
3008668901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$327.16 |
| Rate for Payer: Aetna of VT Commercial |
$327.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.07
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cigna Commercial |
$23.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$323.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$29.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare VA CCN |
$19.35
|
|
|
HTLV/HIV CONFIRMJ ANTIBODY
|
Facility
|
OP
|
$348.04
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
3008668901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$330.64 |
| Rate for Payer: Aetna of VT Commercial |
$330.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$154.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$209.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$281.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$156.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.69
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$156.62
|
| Rate for Payer: Multiplan Commercial |
$323.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.83
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.62
|
| Rate for Payer: United Healthcare Commercial |
$330.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare VA CCN |
$156.62
|
|
|
HTLV/HIV CONFIRMJ ANTIBODY
|
Facility
|
IP
|
$348.04
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
3008668901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.58 |
| Max. Negotiated Rate |
$330.64 |
| Rate for Payer: Aetna of VT Commercial |
$330.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$295.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$292.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$278.43
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$278.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$323.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$295.83
|
| Rate for Payer: United Healthcare Commercial |
$330.64
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5107845201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5107845201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1,553.16 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$416.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$465.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.89
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$631.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$650.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$650.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.52
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$622.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare VA CCN |
$404.52
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1,553.16 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$416.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$465.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.89
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$631.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$650.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$650.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.52
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$622.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare VA CCN |
$404.52
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5107845201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
9607845202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1,553.16 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$416.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$714.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$465.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$714.89
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$631.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$650.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$650.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$404.52
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$404.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$622.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.52
|
| Rate for Payer: United Healthcare VA CCN |
$404.52
|
|
|
HYALURONATE SODIUM
|
Professional
|
Both
|
$408.31
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
636J732301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$383.81 |
| Rate for Payer: Aetna of VT Commercial |
$383.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$353.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$353.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$157.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$129.32
|
| Rate for Payer: Cash Price |
$204.16
|
| Rate for Payer: Cash Price |
$204.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$128.71
|
| Rate for Payer: Multiplan Commercial |
$379.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.45
|
| Rate for Payer: United Healthcare Commercial |
$172.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.45
|
| Rate for Payer: United Healthcare VA CCN |
$112.45
|
|
