|
IMMUNOASSAY TUMOR CA 15-3
|
Facility
|
OP
|
$222.31
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3008630001
|
|
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 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
|
|
|
IMMUNOASSAY TUMOR CA 19-9
|
Professional
|
Both
|
$266.77
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
3008630101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$250.76 |
| Rate for Payer: Aetna of VT Commercial |
$250.76
|
| 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 |
$133.38
|
| Rate for Payer: Cash Price |
$133.38
|
| 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 |
$248.10
|
| 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 19-9
|
Facility
|
OP
|
$266.77
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
3008630101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna of VT Commercial |
$253.43
|
| 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 |
$118.15
|
| 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 |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.08
|
| Rate for Payer: Cash Price |
$133.38
|
| Rate for Payer: Cash Price |
$133.38
|
| Rate for Payer: Cigna Commercial |
$213.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$248.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.05
|
| Rate for Payer: United Healthcare Commercial |
$253.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare VA CCN |
$120.05
|
|
|
IMMUNOASSAY TUMOR CA 19-9
|
Facility
|
IP
|
$266.77
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
3008630101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$197.44 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna of VT Commercial |
$253.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$224.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.42
|
| Rate for Payer: Cash Price |
$133.38
|
| Rate for Payer: Cigna Commercial |
$213.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$213.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$213.42
|
| Rate for Payer: Multiplan Commercial |
$248.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.75
|
| Rate for Payer: United Healthcare Commercial |
$253.43
|
|
|
IMMUNOASSAY TUMOR CA 27.29
|
Facility
|
OP
|
$222.31
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3008630002
|
|
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 27.29
|
Facility
|
IP
|
$222.31
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3008630002
|
|
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 27.29
|
Professional
|
Both
|
$222.31
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
3008630002
|
|
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 |
$28.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.63
|
| 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 |
$28.63
|
| 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
|
|
|
IMMUNOFIXJ ELECTROPHORESIS SER
|
Professional
|
Both
|
$239.89
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
3008633401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$225.50 |
| Rate for Payer: Aetna of VT Commercial |
$225.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.72
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cigna Commercial |
$47.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$22.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$22.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.03
|
| Rate for Payer: Multiplan Commercial |
$223.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare Commercial |
$34.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare VA CCN |
$22.34
|
|
|
IMMUNOFIXJ ELECTROPHORESIS SER
|
Facility
|
OP
|
$239.89
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
3008633401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$227.90 |
| Rate for Payer: Aetna of VT Commercial |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$194.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$107.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$190.71
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cigna Commercial |
$191.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$107.95
|
| Rate for Payer: Multiplan Commercial |
$223.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$107.95
|
| Rate for Payer: United Healthcare Commercial |
$227.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare VA CCN |
$107.95
|
|
|
IMMUNOFIXJ ELECTROPHORESIS SER
|
Facility
|
IP
|
$239.89
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
3008633401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.54 |
| Max. Negotiated Rate |
$227.90 |
| Rate for Payer: Aetna of VT Commercial |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$203.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$201.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.91
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cigna Commercial |
$191.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$191.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$191.91
|
| Rate for Payer: Multiplan Commercial |
$223.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$203.91
|
| Rate for Payer: United Healthcare Commercial |
$227.90
|
|
|
IMMUNOGLOBULIN LIGHT CHAINS FR
|
Facility
|
OP
|
$194.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Aetna of VT Commercial |
$184.67
|
| 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 |
$86.10
|
| 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 |
$117.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.54
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cigna Commercial |
$155.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.48
|
| Rate for Payer: Multiplan Commercial |
$180.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.48
|
| Rate for Payer: United Healthcare Commercial |
$184.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$87.48
|
|
|
IMMUNOGLOBULIN LIGHT CHAINS FR
|
Facility
|
IP
|
$194.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Aetna of VT Commercial |
$184.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.51
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cigna Commercial |
$155.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.51
|
| Rate for Payer: Multiplan Commercial |
$180.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.23
|
| Rate for Payer: United Healthcare Commercial |
$184.67
|
|
|
IMMUNOGLOBULIN LIGHT CHAINS FR
|
Professional
|
Both
|
$194.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
3008352101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$182.73 |
| Rate for Payer: Aetna of VT Commercial |
$182.73
|
| 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 |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.36
|
| 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 |
$20.36
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cash Price |
$97.19
|
| 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 |
$180.78
|
| 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
|
|
|
IMMUNOHISTO ANTB 1ST STAIN
|
Facility
|
OP
|
$272.04
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
3008834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of VT Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.27
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.42
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.42
|
| Rate for Payer: United Healthcare Commercial |
$258.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.10
|
| Rate for Payer: United Healthcare VA CCN |
$122.42
|
|
|
IMMUNOHISTO ANTB 1ST STAIN
|
Professional
|
Both
|
$272.04
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
3008834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Aetna of VT Commercial |
$255.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$111.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$139.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$124.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.04
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$136.45
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.10
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.10
|
| Rate for Payer: United Healthcare Commercial |
$166.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.10
|
| Rate for Payer: United Healthcare VA CCN |
$108.10
|
|
|
IMMUNOHISTO ANTB 1ST STAIN
|
Facility
|
IP
|
$272.04
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
3008834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$258.44 |
| Rate for Payer: Aetna of VT Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.63
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.63
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.23
|
| Rate for Payer: United Healthcare Commercial |
$258.44
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Facility
|
OP
|
$272.04
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
3008834101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$308.17 |
| Rate for Payer: Aetna of VT Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.27
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.42
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.42
|
| Rate for Payer: United Healthcare Commercial |
$258.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.80
|
| Rate for Payer: United Healthcare VA CCN |
$122.42
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Facility
|
IP
|
$272.04
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
3008834101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$258.44 |
| Rate for Payer: Aetna of VT Commercial |
$258.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.63
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.63
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.23
|
| Rate for Payer: United Healthcare Commercial |
$258.44
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Professional
|
Both
|
$272.04
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
3008834101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$308.17 |
| Rate for Payer: Aetna of VT Commercial |
$255.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$308.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$308.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$118.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$106.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.01
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cigna Commercial |
$116.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.80
|
| Rate for Payer: Multiplan Commercial |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$92.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.80
|
| Rate for Payer: United Healthcare Commercial |
$142.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.80
|
| Rate for Payer: United Healthcare VA CCN |
$92.80
|
|
|
IMMUNOHISTO ANTIBODY SLIDE
|
Facility
|
OP
|
$442.55
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
3008834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$658.31 |
| Rate for Payer: Aetna of VT Commercial |
$420.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$196.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$266.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$358.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$199.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$351.83
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cigna Commercial |
$354.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$199.15
|
| Rate for Payer: Multiplan Commercial |
$411.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$199.15
|
| Rate for Payer: United Healthcare Commercial |
$420.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare VA CCN |
$199.15
|
|
|
IMMUNOHISTO ANTIBODY SLIDE
|
Professional
|
Both
|
$442.55
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
3008834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$658.31 |
| Rate for Payer: Aetna of VT Commercial |
$416.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.94
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cigna Commercial |
$222.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$165.93
|
| Rate for Payer: Multiplan Commercial |
$411.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare Commercial |
$255.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.93
|
| Rate for Payer: United Healthcare VA CCN |
$165.93
|
|
|
IMMUNOHISTO ANTIBODY SLIDE
|
Facility
|
IP
|
$442.55
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
3008834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$327.53 |
| Max. Negotiated Rate |
$420.42 |
| Rate for Payer: Aetna of VT Commercial |
$420.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$327.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$327.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$376.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$371.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$354.04
|
| Rate for Payer: Cash Price |
$221.28
|
| Rate for Payer: Cigna Commercial |
$354.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$354.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$354.04
|
| Rate for Payer: Multiplan Commercial |
$411.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.17
|
| Rate for Payer: United Healthcare Commercial |
$420.42
|
|
|
IMPLANT SPINAL CANAL CATH
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9826235001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$871.18 |
| Max. Negotiated Rate |
$1,868.65 |
| Rate for Payer: Aetna of VT Commercial |
$1,868.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$871.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,184.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,671.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,593.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$885.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,563.77
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,573.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,573.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$885.15
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,671.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare Commercial |
$1,868.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$885.15
|
| Rate for Payer: United Healthcare VA CCN |
$885.15
|
|
|
IMPLANT SPINAL CANAL CATH
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
9816235002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$372.41 |
| Max. Negotiated Rate |
$1,848.98 |
| Rate for Payer: Aetna of VT Commercial |
$1,848.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$383.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,762.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$521.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$659.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$428.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$659.10
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$518.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$624.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$624.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$372.41
|
| Rate for Payer: Multiplan Commercial |
$1,829.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$528.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare Commercial |
$572.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$372.41
|
| Rate for Payer: United Healthcare VA CCN |
$372.41
|
|
