|
INTMD RPR S/TR/EXT 7.6-12.5
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9821203401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$688.08 |
| Rate for Payer: Aetna of VT Commercial |
$688.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$199.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$222.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.41
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$513.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$513.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$315.56
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$297.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
INTMD RPR S/TR/EXT 7.6-12.5
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9821203401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$324.20 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$324.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$440.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$592.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$581.94
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$329.40
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.40
|
| Rate for Payer: United Healthcare VA CCN |
$329.40
|
|
|
INTMD RPR S/TR/EXT 7.6-12.5
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
9821203401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$541.75 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna of VT Commercial |
$695.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$541.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$585.60
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$585.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$585.60
|
| Rate for Payer: Multiplan Commercial |
$680.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$622.20
|
| Rate for Payer: United Healthcare Commercial |
$695.40
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
9825179701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$159.06 |
| Max. Negotiated Rate |
$439.92 |
| Rate for Payer: Aetna of VT Commercial |
$439.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$419.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$419.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$325.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$325.12
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$317.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$256.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$256.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$159.07
|
| Rate for Payer: Multiplan Commercial |
$435.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$225.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$159.06
|
| Rate for Payer: United Healthcare Commercial |
$244.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.06
|
| Rate for Payer: United Healthcare VA CCN |
$159.06
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
9825179701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.28 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of VT Commercial |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$419.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$419.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.06
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$374.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$435.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$397.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$210.60
|
| Rate for Payer: United Healthcare Commercial |
$444.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.60
|
| Rate for Payer: United Healthcare VA CCN |
$210.60
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
9825179701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$346.37 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna of VT Commercial |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$346.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$346.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$374.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$374.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$374.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$435.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$397.80
|
| Rate for Payer: United Healthcare Commercial |
$444.60
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
OP
|
$504.09
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
3008833301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$478.89 |
| Rate for Payer: Aetna of VT Commercial |
$478.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$223.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$303.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$408.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$226.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$400.75
|
| Rate for Payer: Cash Price |
$252.04
|
| Rate for Payer: Cash Price |
$252.04
|
| Rate for Payer: Cigna Commercial |
$403.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.84
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.84
|
| Rate for Payer: United Healthcare Commercial |
$478.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.50
|
| Rate for Payer: United Healthcare VA CCN |
$226.84
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Professional
|
Both
|
$504.09
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
3008833301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$473.84 |
| Rate for Payer: Aetna of VT Commercial |
$473.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$126.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.78
|
| Rate for Payer: Cash Price |
$252.04
|
| Rate for Payer: Cash Price |
$252.04
|
| Rate for Payer: Cigna Commercial |
$117.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$134.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.50
|
| Rate for Payer: United Healthcare VA CCN |
$87.50
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
IP
|
$504.09
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
3008833301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$373.08 |
| Max. Negotiated Rate |
$478.89 |
| Rate for Payer: Aetna of VT Commercial |
$478.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$373.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$373.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$428.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$423.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$403.27
|
| Rate for Payer: Cash Price |
$252.04
|
| Rate for Payer: Cigna Commercial |
$403.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.27
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$428.48
|
| Rate for Payer: United Healthcare Commercial |
$478.89
|
|
|
INTRINSIC FACTOR ANTIBODIES
|
Facility
|
OP
|
$283.56
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
3008634001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of VT Commercial |
$269.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$127.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$225.43
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cigna Commercial |
$226.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$263.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$127.60
|
| Rate for Payer: United Healthcare Commercial |
$269.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare VA CCN |
$127.60
|
|
|
INTRINSIC FACTOR ANTIBODIES
|
Professional
|
Both
|
$283.56
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
3008634001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$266.55 |
| Rate for Payer: Aetna of VT Commercial |
$266.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$74.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.79
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cigna Commercial |
$18.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.87
|
| Rate for Payer: Multiplan Commercial |
$263.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$23.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare VA CCN |
$15.08
|
|
|
INTRINSIC FACTOR ANTIBODIES
|
Facility
|
IP
|
$283.56
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
3008634001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.86 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Aetna of VT Commercial |
$269.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$241.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$226.85
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cigna Commercial |
$226.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$226.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$226.85
|
| Rate for Payer: Multiplan Commercial |
$263.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$241.03
|
| Rate for Payer: United Healthcare Commercial |
$269.38
|
|
|
Iodine I-123 Ioflupane
|
Facility
|
IP
|
$7,912.17
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
343A958401
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5,855.80 |
| Max. Negotiated Rate |
$7,516.56 |
| Rate for Payer: Aetna of VT Commercial |
$7,516.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,855.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,855.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,725.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,646.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,329.74
|
| Rate for Payer: Cash Price |
$3,956.08
|
| Rate for Payer: Cigna Commercial |
$6,329.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,329.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,329.74
|
| Rate for Payer: Multiplan Commercial |
$7,358.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,725.34
|
| Rate for Payer: United Healthcare Commercial |
$7,516.56
|
|
|
Iodine I-123 Ioflupane
|
Facility
|
OP
|
$7,912.17
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
343A958401
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,504.30 |
| Max. Negotiated Rate |
$7,516.56 |
| Rate for Payer: Aetna of VT Commercial |
$7,516.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7,088.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,504.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7,088.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,763.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,725.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,408.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,560.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,290.18
|
| Rate for Payer: Cash Price |
$3,956.08
|
| Rate for Payer: Cigna Commercial |
$6,329.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,329.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,329.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,560.48
|
| Rate for Payer: Multiplan Commercial |
$7,358.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,725.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,560.48
|
| Rate for Payer: United Healthcare Commercial |
$7,516.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,560.48
|
| Rate for Payer: United Healthcare VA CCN |
$3,560.48
|
|
|
IO MAP OF SENT LYMPH NODE
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
9823890001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$182.03 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Aetna of VT Commercial |
$390.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$247.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$332.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$184.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$326.75
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$184.95
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare Commercial |
$390.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.95
|
| Rate for Payer: United Healthcare VA CCN |
$184.95
|
|
|
IO MAP OF SENT LYMPH NODE
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
9823890001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$386.34 |
| Rate for Payer: Aetna of VT Commercial |
$386.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$368.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.18
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$226.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$123.51
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.51
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.51
|
| Rate for Payer: United Healthcare VA CCN |
$123.51
|
|
|
IO MAP OF SENT LYMPH NODE
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
9823890001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$304.18 |
| Max. Negotiated Rate |
$390.45 |
| Rate for Payer: Aetna of VT Commercial |
$390.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$304.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$304.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$349.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$328.80
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$328.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$382.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$349.35
|
| Rate for Payer: United Healthcare Commercial |
$390.45
|
|
|
IP/OBS CNSLTJ NEW/EST LOW 45
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
9879925301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$252.86 |
| Rate for Payer: Aetna of VT Commercial |
$252.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$180.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.51
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$102.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.85
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: United Healthcare Commercial |
$228.65
|
| Rate for Payer: United Healthcare VA CCN |
$98.37
|
|
|
IP/OBS CNSLTJ NEW/EST LOW 45
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
9879925301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna of VT Commercial |
$255.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$241.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.85
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.05
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.05
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.05
|
| Rate for Payer: United Healthcare VA CCN |
$121.05
|
|
|
IP/OBS CNSLTJ NEW/EST LOW 45
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
9879925301
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$199.09 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna of VT Commercial |
$255.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.20
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.20
|
| Rate for Payer: Multiplan Commercial |
$250.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.65
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
|
|
IP/OBS CNSLTJ NEW/EST MOD 60
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
9879925401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna of VT Commercial |
$280.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$260.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$260.36
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$141.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$211.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$211.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.17
|
| Rate for Payer: Multiplan Commercial |
$277.14
|
| Rate for Payer: United Healthcare Commercial |
$253.30
|
| Rate for Payer: United Healthcare VA CCN |
$136.57
|
|
|
IP/OBS CNSLTJ NEW/EST MOD 60
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
9879925401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$220.55 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Aetna of VT Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$220.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$220.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$238.40
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$238.40
|
| Rate for Payer: Multiplan Commercial |
$277.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.30
|
| Rate for Payer: United Healthcare Commercial |
$283.10
|
|
|
IP/OBS CNSLTJ NEW/EST MOD 60
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
9879925401
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$131.98 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Aetna of VT Commercial |
$283.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$179.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$253.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$134.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.91
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$238.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$238.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$134.10
|
| Rate for Payer: Multiplan Commercial |
$277.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$134.10
|
| Rate for Payer: United Healthcare Commercial |
$283.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.10
|
| Rate for Payer: United Healthcare VA CCN |
$134.10
|
|
|
IP/OBS CONSLTJ NEW/EST HI 80
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
CPT 99255
|
| Hospital Charge Code |
9879925501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$174.79 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna of VT Commercial |
$558.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$344.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$344.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.35
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$283.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$283.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$174.79
|
| Rate for Payer: Multiplan Commercial |
$552.42
|
| Rate for Payer: United Healthcare Commercial |
$504.90
|
| Rate for Payer: United Healthcare VA CCN |
$183.36
|
|
|
IP/OBS CONSLTJ NEW/EST HI 80
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 99255
|
| Hospital Charge Code |
9879925501
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$263.08 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna of VT Commercial |
$564.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$263.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$357.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$481.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$472.23
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$475.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$475.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$475.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.30
|
| Rate for Payer: Multiplan Commercial |
$552.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$504.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$267.30
|
| Rate for Payer: United Healthcare Commercial |
$564.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.30
|
| Rate for Payer: United Healthcare VA CCN |
$267.30
|
|
