|
IMFLUOR 1ST 1ANTB STAIN PX
|
Professional
|
Both
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3008834601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.79 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of VT Commercial |
$217.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$159.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.93
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$192.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$222.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$222.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.79
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare Commercial |
$213.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare VA CCN |
$138.79
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Facility
|
OP
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3108834601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.66 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of VT Commercial |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$197.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.27
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.31
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$220.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare VA CCN |
$104.31
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Facility
|
OP
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3108334601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.66 |
| Max. Negotiated Rate |
$558.24 |
| Rate for Payer: Aetna of VT Commercial |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$102.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$139.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$197.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$187.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.27
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$104.31
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.31
|
| Rate for Payer: United Healthcare Commercial |
$220.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.79
|
| Rate for Payer: United Healthcare VA CCN |
$104.31
|
|
|
IMFLUOR 1ST 1ANTB STAIN PX
|
Facility
|
IP
|
$231.79
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3108334601
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.55 |
| Max. Negotiated Rate |
$220.20 |
| Rate for Payer: Aetna of VT Commercial |
$220.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$171.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$171.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$197.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$185.43
|
| Rate for Payer: Cash Price |
$115.89
|
| Rate for Payer: Cigna Commercial |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.43
|
| Rate for Payer: Multiplan Commercial |
$215.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.02
|
| Rate for Payer: United Healthcare Commercial |
$220.20
|
|
|
IMFLUOR EA ADDL 1ANTB STN PX
|
Facility
|
IP
|
$170.47
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
3108835001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.16 |
| Max. Negotiated Rate |
$161.95 |
| Rate for Payer: Aetna of VT Commercial |
$161.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.38
|
| Rate for Payer: Cash Price |
$85.24
|
| Rate for Payer: Cigna Commercial |
$136.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.38
|
| Rate for Payer: Multiplan Commercial |
$158.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
|
|
IMFLUOR EA ADDL 1ANTB STN PX
|
Facility
|
OP
|
$170.47
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
3108835001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.50 |
| Max. Negotiated Rate |
$416.28 |
| Rate for Payer: Aetna of VT Commercial |
$161.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.52
|
| Rate for Payer: Cash Price |
$85.24
|
| Rate for Payer: Cash Price |
$85.24
|
| Rate for Payer: Cigna Commercial |
$136.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$158.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.71
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.14
|
| Rate for Payer: United Healthcare VA CCN |
$76.71
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
OP
|
$41.36
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7719047301
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$39.29 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.88
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.61
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.61
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.61
|
| Rate for Payer: United Healthcare VA CCN |
$18.61
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Facility
|
IP
|
$41.36
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7719047301
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$39.29 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.09
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
|
|
IMMUNE ADMIN ORAL/NASAL
|
Professional
|
Both
|
$41.36
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
7719047301
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna of VT Commercial |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.29
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$16.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.94
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.94
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.94
|
| Rate for Payer: United Healthcare VA CCN |
$20.50
|
|
|
IMMUNFIX E-PHORSIS/URINE/CSF
|
Professional
|
Both
|
$127.02
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3008633501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$144.62 |
| Rate for Payer: Aetna of VT Commercial |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$54.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.73
|
| Rate for Payer: Cash Price |
$63.51
|
| Rate for Payer: Cash Price |
$63.51
|
| Rate for Payer: Cigna Commercial |
$56.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.94
|
| Rate for Payer: Multiplan Commercial |
$118.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare Commercial |
$45.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare VA CCN |
$29.35
|
|
|
IMMUNFIX E-PHORSIS/URINE/CSF
|
Facility
|
OP
|
$127.02
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3008633501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$144.62 |
| Rate for Payer: Aetna of VT Commercial |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.98
|
| Rate for Payer: Cash Price |
$63.51
|
| Rate for Payer: Cash Price |
$63.51
|
| Rate for Payer: Cigna Commercial |
$101.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.16
|
| Rate for Payer: Multiplan Commercial |
$118.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.16
|
| Rate for Payer: United Healthcare Commercial |
$120.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare VA CCN |
$57.16
|
|
|
IMMUNFIX E-PHORSIS/URINE/CSF
|
Facility
|
IP
|
$127.02
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
3008633501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.01 |
| Max. Negotiated Rate |
$120.67 |
| Rate for Payer: Aetna of VT Commercial |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$107.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.62
|
| Rate for Payer: Cash Price |
$63.51
|
| Rate for Payer: Cigna Commercial |
$101.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.62
|
| Rate for Payer: Multiplan Commercial |
$118.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.97
|
| Rate for Payer: United Healthcare Commercial |
$120.67
|
|
|
IMMUNOASSAY INFECTIOUS AGENT
|
Professional
|
Both
|
$198.53
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3008631701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna of VT Commercial |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.82
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cigna Commercial |
$18.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.78
|
| Rate for Payer: Multiplan Commercial |
$184.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare Commercial |
$23.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare VA CCN |
$14.99
|
|
|
IMMUNOASSAY INFECTIOUS AGENT
|
Facility
|
OP
|
$198.53
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3008631701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna of VT Commercial |
$188.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.83
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cigna Commercial |
$158.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.34
|
| Rate for Payer: Multiplan Commercial |
$184.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.34
|
| Rate for Payer: United Healthcare Commercial |
$188.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare VA CCN |
$89.34
|
|
|
IMMUNOASSAY INFECTIOUS AGENT
|
Facility
|
IP
|
$198.53
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
3008631701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.93 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna of VT Commercial |
$188.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$158.82
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cigna Commercial |
$158.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.82
|
| Rate for Payer: Multiplan Commercial |
$184.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.75
|
| Rate for Payer: United Healthcare Commercial |
$188.60
|
|
|
IMMUNOASSAY NONANTIBODY
|
Facility
|
IP
|
$189.38
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3008351601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$179.91 |
| Rate for Payer: Aetna of VT Commercial |
$179.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.50
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna Commercial |
$151.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.97
|
| Rate for Payer: United Healthcare Commercial |
$179.91
|
|
|
IMMUNOASSAY NONANTIBODY
|
Facility
|
OP
|
$189.38
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3008351601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$179.91 |
| Rate for Payer: Aetna of VT Commercial |
$179.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$160.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$150.56
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna Commercial |
$151.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$151.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$151.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.22
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.22
|
| Rate for Payer: United Healthcare Commercial |
$179.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare VA CCN |
$85.22
|
|
|
IMMUNOASSAY NONANTIBODY
|
Professional
|
Both
|
$189.38
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
3008351601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$178.02 |
| Rate for Payer: Aetna of VT Commercial |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.71
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.37
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$17.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare VA CCN |
$11.53
|
|
|
IMMUNOASSAY QUANT ustekinumab
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3008352001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.58 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna of VT Commercial |
$294.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$248.16
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$248.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.16
|
| Rate for Payer: Multiplan Commercial |
$288.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.67
|
| Rate for Payer: United Healthcare Commercial |
$294.69
|
|
|
IMMUNOASSAY QUANT ustekinumab
|
Professional
|
Both
|
$310.20
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3008352001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$291.59 |
| Rate for Payer: Aetna of VT Commercial |
$291.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.42
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$21.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$288.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$26.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$17.27
|
|
|
IMMUNOASSAY QUANT ustekinumab
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3008352001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna of VT Commercial |
$294.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$137.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$263.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.61
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$248.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$248.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$248.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.59
|
| Rate for Payer: Multiplan Commercial |
$288.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$263.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.59
|
| Rate for Payer: United Healthcare Commercial |
$294.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$139.59
|
|
|
IMMUNOASSAY TUMOR CA 125
|
Professional
|
Both
|
$222.31
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
3008630401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$208.97 |
| Rate for Payer: Aetna of VT Commercial |
$208.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.57
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cigna Commercial |
$25.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$32.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare VA CCN |
$20.81
|
|
|
IMMUNOASSAY TUMOR CA 125
|
Facility
|
OP
|
$222.31
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
3008630401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna of VT Commercial |
$211.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$133.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.74
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cigna Commercial |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.04
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.04
|
| Rate for Payer: United Healthcare Commercial |
$211.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare VA CCN |
$100.04
|
|
|
IMMUNOASSAY TUMOR CA 125
|
Facility
|
IP
|
$222.31
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
3008630401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.53 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna of VT Commercial |
$211.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.85
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cigna Commercial |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.85
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.96
|
| Rate for Payer: United Healthcare Commercial |
$211.19
|
|
|
IMMUNOASSAY TUMOR CA 15-3
|
Facility
|
IP
|
$222.31
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3008630001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.53 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna of VT Commercial |
$211.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$164.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$164.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$188.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.85
|
| Rate for Payer: Cash Price |
$111.16
|
| Rate for Payer: Cigna Commercial |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$177.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$177.85
|
| Rate for Payer: Multiplan Commercial |
$206.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$188.96
|
| Rate for Payer: United Healthcare Commercial |
$211.19
|
|
