|
IAADIADOO NOT OTHERWISE SPECIF
|
Professional
|
Both
|
$183.34
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
3008789901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$172.34 |
| Rate for Payer: Aetna of VT Commercial |
$172.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.15
|
| Rate for Payer: Cash Price |
$91.67
|
| Rate for Payer: Cash Price |
$91.67
|
| Rate for Payer: Cigna Commercial |
$19.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.85
|
| Rate for Payer: Multiplan Commercial |
$170.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$24.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare VA CCN |
$16.07
|
|
|
IAAD IA HPYLORI STOOL
|
Facility
|
OP
|
$215.07
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
3008733801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$204.32 |
| Rate for Payer: Aetna of VT Commercial |
$204.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.98
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: Cigna Commercial |
$172.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.78
|
| Rate for Payer: Multiplan Commercial |
$200.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.78
|
| Rate for Payer: United Healthcare Commercial |
$204.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: United Healthcare VA CCN |
$96.78
|
|
|
IAAD IA HPYLORI STOOL
|
Facility
|
IP
|
$215.07
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
3008733801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$204.32 |
| Rate for Payer: Aetna of VT Commercial |
$204.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.06
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: Cigna Commercial |
$172.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.06
|
| Rate for Payer: Multiplan Commercial |
$200.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.81
|
| Rate for Payer: United Healthcare Commercial |
$204.32
|
|
|
IAAD IA HPYLORI STOOL
|
Professional
|
Both
|
$215.07
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
3008733801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$202.17 |
| Rate for Payer: Aetna of VT Commercial |
$202.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$70.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$70.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.59
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: Cigna Commercial |
$17.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$200.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.38
|
| Rate for Payer: United Healthcare Commercial |
$22.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.38
|
| Rate for Payer: United Healthcare VA CCN |
$14.38
|
|
|
IAADI CRYPTOSPORIDIUM
|
Facility
|
OP
|
$144.76
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
3008727201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna of VT Commercial |
$137.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.08
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.14
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.14
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare VA CCN |
$65.14
|
|
|
IAADI CRYPTOSPORIDIUM
|
Professional
|
Both
|
$144.76
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
3008727201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$136.07 |
| Rate for Payer: Aetna of VT Commercial |
$136.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.47
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.81
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare VA CCN |
$11.98
|
|
|
IAADI CRYPTOSPORIDIUM
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
3008727201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna of VT Commercial |
$137.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.81
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.81
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.05
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
|
|
IAADI GIARDIA
|
Professional
|
Both
|
$97.20
|
|
|
Service Code
|
CPT 87269
|
| Hospital Charge Code |
3008726901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna of VT Commercial |
$91.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.25
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.61
|
| Rate for Payer: United Healthcare Commercial |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.61
|
| Rate for Payer: United Healthcare VA CCN |
$13.61
|
|
|
IAADI GIARDIA
|
Facility
|
OP
|
$97.20
|
|
|
Service Code
|
CPT 87269
|
| Hospital Charge Code |
3008726901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna of VT Commercial |
$92.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$58.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.27
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$77.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.74
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.74
|
| Rate for Payer: United Healthcare Commercial |
$92.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.61
|
| Rate for Payer: United Healthcare VA CCN |
$43.74
|
|
|
IAADI GIARDIA
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
CPT 87269
|
| Hospital Charge Code |
3008726901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.94 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna of VT Commercial |
$92.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$81.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$77.76
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$77.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$77.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.62
|
| Rate for Payer: United Healthcare Commercial |
$92.34
|
|
|
IADNA CYTOMEGALOVIRUS QUANTIFI
|
Facility
|
IP
|
$378.77
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
3008749701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$280.33 |
| Max. Negotiated Rate |
$359.83 |
| Rate for Payer: Aetna of VT Commercial |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$280.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$280.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$318.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$303.02
|
| Rate for Payer: Cash Price |
$189.38
|
| Rate for Payer: Cigna Commercial |
$303.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$303.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$303.02
|
| Rate for Payer: Multiplan Commercial |
$352.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.95
|
| Rate for Payer: United Healthcare Commercial |
$359.83
|
|
|
IADNA CYTOMEGALOVIRUS QUANTIFI
|
Professional
|
Both
|
$378.77
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
3008749701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$356.04 |
| Rate for Payer: Aetna of VT Commercial |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$44.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$49.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$73.22
|
| Rate for Payer: Cash Price |
$189.38
|
| Rate for Payer: Cash Price |
$189.38
|
| Rate for Payer: Cigna Commercial |
$51.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$42.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$42.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$352.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$65.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$42.84
|
|
|
IADNA CYTOMEGALOVIRUS QUANTIFI
|
Facility
|
OP
|
$378.77
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
3008749701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$359.83 |
| Rate for Payer: Aetna of VT Commercial |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$211.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$228.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$321.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$306.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$301.12
|
| Rate for Payer: Cash Price |
$189.38
|
| Rate for Payer: Cash Price |
$189.38
|
| Rate for Payer: Cigna Commercial |
$303.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$303.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$303.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.45
|
| Rate for Payer: Multiplan Commercial |
$352.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$170.45
|
| Rate for Payer: United Healthcare Commercial |
$359.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare VA CCN |
$170.45
|
|
|
IADNA-DNA/RNA PROBE TQ 12-25
|
Facility
|
OP
|
$667.96
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
3008750701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.84 |
| Max. Negotiated Rate |
$2,053.68 |
| Rate for Payer: Aetna of VT Commercial |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,053.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,053.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$402.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$567.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$541.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$300.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.03
|
| Rate for Payer: Cash Price |
$333.98
|
| Rate for Payer: Cash Price |
$333.98
|
| Rate for Payer: Cigna Commercial |
$534.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$534.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$534.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$300.58
|
| Rate for Payer: Multiplan Commercial |
$621.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$567.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$300.58
|
| Rate for Payer: United Healthcare Commercial |
$634.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare VA CCN |
$300.58
|
|
|
IADNA-DNA/RNA PROBE TQ 12-25
|
Facility
|
IP
|
$667.96
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
3008750701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$494.36 |
| Max. Negotiated Rate |
$634.56 |
| Rate for Payer: Aetna of VT Commercial |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$494.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$494.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$567.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$561.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$534.37
|
| Rate for Payer: Cash Price |
$333.98
|
| Rate for Payer: Cigna Commercial |
$534.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$534.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$534.37
|
| Rate for Payer: Multiplan Commercial |
$621.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$567.77
|
| Rate for Payer: United Healthcare Commercial |
$634.56
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUS
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUS
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 4580213326
|
| Hospital Charge Code |
2500000138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
IBUPROFEN 200 MG TAB
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
IBUPROFEN 200 MG TAB
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 904791461
|
| Hospital Charge Code |
2500000405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
IBUPROFEN 800 MG TAB
|
Professional
|
Both
|
$0.03
|
|
| Hospital Charge Code |
2500000407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
IBUPROFEN 800 MG TAB
|
Professional
|
Both
|
$0.03
|
|
|
Service Code
|
NDC 904585561
|
| Hospital Charge Code |
2500000407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.03
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.01
|
|
|
I&D ABSCESS COMPLICATED/MULTI
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
5101006101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$334.53 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Aetna of VT Commercial |
$429.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$334.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$334.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$384.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.60
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$361.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$361.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$420.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.20
|
| Rate for Payer: United Healthcare Commercial |
$429.40
|
|
|
I&D ABSCESS COMPLICATED/MULTI
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
9601006102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$290.86 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna of VT Commercial |
$373.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$314.40
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$314.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$365.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.05
|
| Rate for Payer: United Healthcare Commercial |
$373.35
|
|
|
I&D ABSCESS COMPLICATED/MULTI
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
9601006101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$625.38 |
| Max. Negotiated Rate |
$802.75 |
| Rate for Payer: Aetna of VT Commercial |
$802.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$625.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$625.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$718.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$709.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$676.00
|
| Rate for Payer: Cash Price |
$422.50
|
| Rate for Payer: Cigna Commercial |
$676.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$676.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$676.00
|
| Rate for Payer: Multiplan Commercial |
$785.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$718.25
|
| Rate for Payer: United Healthcare Commercial |
$802.75
|
|
|
I&D ABSCESS COMPLICATED/MULTI
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
4501006101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.93 |
| Max. Negotiated Rate |
$428.64 |
| Rate for Payer: Aetna of VT Commercial |
$428.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$333.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$333.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$360.96
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$360.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$360.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$360.96
|
| Rate for Payer: Multiplan Commercial |
$419.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$383.52
|
| Rate for Payer: United Healthcare Commercial |
$428.64
|
|
