|
LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$116.84
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3008661701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$52.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.89
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$52.58
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$52.58
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: United Healthcare VA CCN |
$52.58
|
|
|
LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$116.84
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
3008661701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna of VT Commercial |
$111.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$93.47
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$93.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$93.47
|
| Rate for Payer: Multiplan Commercial |
$108.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$99.31
|
| Rate for Payer: United Healthcare Commercial |
$111.00
|
|
|
LYMPH SYSTEM IMAGING
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
9727819501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
|
|
LYMPH SYSTEM IMAGING
|
Facility
|
OP
|
$2,909.68
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
3417819501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,164.86 |
| Max. Negotiated Rate |
$2,764.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,764.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,164.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,288.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,164.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,751.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,473.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,356.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,309.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,313.20
|
| Rate for Payer: Cash Price |
$1,454.84
|
| Rate for Payer: Cash Price |
$1,454.84
|
| Rate for Payer: Cigna Commercial |
$2,327.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,327.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,327.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,309.36
|
| Rate for Payer: Multiplan Commercial |
$2,706.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,473.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,309.36
|
| Rate for Payer: United Healthcare Commercial |
$2,764.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,309.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,309.36
|
|
|
LYMPH SYSTEM IMAGING
|
Facility
|
IP
|
$2,909.68
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
3417819501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,153.45 |
| Max. Negotiated Rate |
$2,764.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,764.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,153.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,153.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,473.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,444.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,327.74
|
| Rate for Payer: Cash Price |
$1,454.84
|
| Rate for Payer: Cigna Commercial |
$2,327.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,327.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,327.74
|
| Rate for Payer: Multiplan Commercial |
$2,706.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,473.23
|
| Rate for Payer: United Healthcare Commercial |
$2,764.20
|
|
|
LYMPH SYSTEM IMAGING
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
9727819501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$1,164.86 |
| Rate for Payer: Aetna of VT Commercial |
$157.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,164.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$313.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,164.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$425.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$475.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$475.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$349.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$475.84
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$471.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$489.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$489.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$304.20
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare Commercial |
$467.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.20
|
| Rate for Payer: United Healthcare VA CCN |
$304.20
|
|
|
LYMPH SYSTEM IMAGING
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
9727819501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare VA CCN |
$75.60
|
|
|
LYSIS OF LABIAL LESION(S)
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
9695644101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$146.17 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna of VT Commercial |
$427.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$150.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$204.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$265.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$168.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$259.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$281.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$281.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$171.55
|
| Rate for Payer: Multiplan Commercial |
$423.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$146.17
|
| Rate for Payer: United Healthcare Commercial |
$224.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.17
|
| Rate for Payer: United Healthcare VA CCN |
$146.17
|
|
|
LYSIS OF LABIAL LESION(S)
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
9695644101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Aetna of VT Commercial |
$432.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$423.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$386.75
|
| Rate for Payer: United Healthcare Commercial |
$432.25
|
|
|
LYSIS OF LABIAL LESION(S)
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
9695644101
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$201.52 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Aetna of VT Commercial |
$432.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$201.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$407.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$273.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$386.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$368.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$204.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$361.73
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$364.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$364.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$423.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$386.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$204.75
|
| Rate for Payer: United Healthcare Commercial |
$432.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.75
|
| Rate for Payer: United Healthcare VA CCN |
$204.75
|
|
|
MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
OP
|
$24.82
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3008716801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$23.58 |
| Rate for Payer: Aetna of VT Commercial |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.73
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cigna Commercial |
$19.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$23.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.17
|
| Rate for Payer: United Healthcare Commercial |
$23.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$11.17
|
|
|
MACROSCOPIC EXAM ARTHROPOD
|
Professional
|
Both
|
$24.82
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3008716801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna of VT Commercial |
$23.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.29
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$23.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$4.27
|
|
|
MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
IP
|
$24.82
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3008716801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$23.58 |
| Rate for Payer: Aetna of VT Commercial |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.86
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cigna Commercial |
$19.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$23.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.10
|
| Rate for Payer: United Healthcare Commercial |
$23.58
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$78.58
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
3008716901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna of VT Commercial |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.47
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna Commercial |
$62.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.36
|
| Rate for Payer: Multiplan Commercial |
$73.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.36
|
| Rate for Payer: United Healthcare Commercial |
$74.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.31
|
| Rate for Payer: United Healthcare VA CCN |
$35.36
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
IP
|
$78.58
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
3008716901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna of VT Commercial |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.86
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna Commercial |
$62.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.86
|
| Rate for Payer: Multiplan Commercial |
$73.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.79
|
| Rate for Payer: United Healthcare Commercial |
$74.65
|
|
|
MACROSCOPIC EXAM PARASITE
|
Professional
|
Both
|
$78.58
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
3008716901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna of VT Commercial |
$73.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.38
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cash Price |
$39.29
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$73.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.31
|
| Rate for Payer: United Healthcare Commercial |
$6.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.31
|
| Rate for Payer: United Healthcare VA CCN |
$4.31
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.61
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.10
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare VA CCN |
$161.10
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$264.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$286.40
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$358.95 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$358.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$407.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$388.00
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
|
|
MANIPULAT PALM CORD POST INJ
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
5102634101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$183.10 |
| Rate for Payer: Aetna of VT Commercial |
$120.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.06
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$141.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.09
|
| Rate for Payer: Multiplan Commercial |
$119.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare Commercial |
$114.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare VA CCN |
$74.51
|
|
|
MANIPULAT PALM CORD POST INJ
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$455.90 |
| Rate for Payer: Aetna of VT Commercial |
$455.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.06
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$141.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.09
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare Commercial |
$114.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare VA CCN |
$74.51
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$214.81 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Aetna of VT Commercial |
$460.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$434.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$291.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$412.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$392.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$218.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$385.57
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$388.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$388.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$451.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare Commercial |
$460.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.25
|
| Rate for Payer: United Healthcare VA CCN |
$218.25
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
5102634101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna of VT Commercial |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$114.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.76
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$102.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$102.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$102.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$119.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.60
|
| Rate for Payer: United Healthcare Commercial |
$121.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.60
|
| Rate for Payer: United Healthcare VA CCN |
$57.60
|
|
|
MANIPULAT PALM CORD POST INJ
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
5102634101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.73 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna of VT Commercial |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$108.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$107.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.40
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$102.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$102.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$119.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.80
|
| Rate for Payer: United Healthcare Commercial |
$121.60
|
|
|
MANIPULAT PALM CORD POST INJ
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
9602634102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$336.52 |
| Rate for Payer: Aetna of VT Commercial |
$336.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.06
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$141.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.09
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare Commercial |
$114.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.51
|
| Rate for Payer: United Healthcare VA CCN |
$74.51
|
|
