|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna of VT Commercial |
$198.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$177.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.20
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$167.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$167.20
|
| Rate for Payer: Multiplan Commercial |
$194.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$212.41 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna of VT Commercial |
$272.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$212.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$243.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.60
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$229.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$243.95
|
| Rate for Payer: United Healthcare Commercial |
$272.65
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
9602061201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna of VT Commercial |
$269.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$257.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$84.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.94
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$72.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$101.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$101.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.90
|
| Rate for Payer: Multiplan Commercial |
$266.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare Commercial |
$59.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.45
|
| Rate for Payer: United Healthcare VA CCN |
$38.45
|
|
|
ASPR/INJ GANGLION CYST ANY LOC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
5102061201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Professional
|
Both
|
$87.89
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3008408001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna of VT Commercial |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.27
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$22.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare VA CCN |
$14.78
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Facility
|
OP
|
$87.89
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3008408001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Aetna of VT Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.87
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cigna Commercial |
$70.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.55
|
| Rate for Payer: Multiplan Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.55
|
| Rate for Payer: United Healthcare Commercial |
$83.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare VA CCN |
$39.55
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Facility
|
IP
|
$87.89
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3008408001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Aetna of VT Commercial |
$83.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.31
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cigna Commercial |
$70.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.31
|
| Rate for Payer: Multiplan Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.71
|
| Rate for Payer: United Healthcare Commercial |
$83.50
|
|
|
ASSAY BLD/SERUM CHOLESTEROL
|
Facility
|
OP
|
$81.69
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3008246501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.94
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.76
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare VA CCN |
$36.76
|
|
|
ASSAY BLD/SERUM CHOLESTEROL
|
Facility
|
IP
|
$81.69
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3008246501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.35
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
|
|
ASSAY BLD/SERUM CHOLESTEROL
|
Professional
|
Both
|
$81.69
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
3008246501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna of VT Commercial |
$76.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.44
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare Commercial |
$6.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare VA CCN |
$4.35
|
|
|
ASSAY DIPROPYLACETIC ACD TOT
|
Facility
|
IP
|
$190.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
3008016401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$180.98 |
| Rate for Payer: Aetna of VT Commercial |
$180.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$141.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.41
|
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Cigna Commercial |
$152.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.41
|
| Rate for Payer: Multiplan Commercial |
$177.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.93
|
| Rate for Payer: United Healthcare Commercial |
$180.98
|
|
|
ASSAY DIPROPYLACETIC ACD TOT
|
Professional
|
Both
|
$190.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
3008016401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$179.08 |
| Rate for Payer: Aetna of VT Commercial |
$179.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.14
|
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Cigna Commercial |
$16.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.35
|
| Rate for Payer: Multiplan Commercial |
$177.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare Commercial |
$20.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare VA CCN |
$13.54
|
|
|
ASSAY DIPROPYLACETIC ACD TOT
|
Facility
|
OP
|
$190.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
3008016401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$180.98 |
| Rate for Payer: Aetna of VT Commercial |
$180.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.46
|
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Cash Price |
$95.25
|
| Rate for Payer: Cigna Commercial |
$152.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.73
|
| Rate for Payer: Multiplan Commercial |
$177.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.93
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.73
|
| Rate for Payer: United Healthcare Commercial |
$180.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare VA CCN |
$85.73
|
|
|
ASSAY FOR CALPROTECTIN FECAL
|
Facility
|
OP
|
$369.49
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
3008399301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna of VT Commercial |
$351.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$222.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$299.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$293.74
|
| Rate for Payer: Cash Price |
$184.74
|
| Rate for Payer: Cash Price |
$184.74
|
| Rate for Payer: Cigna Commercial |
$295.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$166.27
|
| Rate for Payer: Multiplan Commercial |
$343.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$166.27
|
| Rate for Payer: United Healthcare Commercial |
$351.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare VA CCN |
$166.27
|
|
|
ASSAY FOR CALPROTECTIN FECAL
|
Professional
|
Both
|
$369.49
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
3008399301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna of VT Commercial |
$347.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$96.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$96.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.54
|
| Rate for Payer: Cash Price |
$184.74
|
| Rate for Payer: Cash Price |
$184.74
|
| Rate for Payer: Cigna Commercial |
$23.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$343.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare Commercial |
$30.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare VA CCN |
$19.63
|
|
|
ASSAY FOR CALPROTECTIN FECAL
|
Facility
|
IP
|
$369.49
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
3008399301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$273.46 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna of VT Commercial |
$351.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$273.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$273.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$314.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$295.59
|
| Rate for Payer: Cash Price |
$184.74
|
| Rate for Payer: Cigna Commercial |
$295.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$295.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$295.59
|
| Rate for Payer: Multiplan Commercial |
$343.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.07
|
| Rate for Payer: United Healthcare Commercial |
$351.02
|
|
|
ASSAY FOR PHENCYCLIDINE
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3008399201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.72
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
|
|
ASSAY FOR PHENCYCLIDINE
|
Professional
|
Both
|
$103.40
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3008399201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$222.67 |
| Rate for Payer: Aetna of VT Commercial |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.81
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$43.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.69
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: United Healthcare Commercial |
$87.89
|
| Rate for Payer: United Healthcare VA CCN |
$22.00
|
|
|
ASSAY FOR PHENCYCLIDINE
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
3008399201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$222.67 |
| Rate for Payer: Aetna of VT Commercial |
$98.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$87.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.20
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna Commercial |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$87.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare Commercial |
$98.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: United Healthcare VA CCN |
$46.53
|
|
|
ASSAY GLUCOSE BLOOD QUANT
|
Facility
|
OP
|
$42.91
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3008294701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna of VT Commercial |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.11
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna Commercial |
$34.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$39.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.31
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare VA CCN |
$19.31
|
|
|
ASSAY GLUCOSE BLOOD QUANT
|
Facility
|
IP
|
$42.91
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
3008294701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna of VT Commercial |
$40.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.33
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna Commercial |
$34.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.33
|
| Rate for Payer: Multiplan Commercial |
$39.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.47
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
|
|
ASSAY IGA/IGD/IGG/IGM EACH
|
Facility
|
IP
|
$96.16
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3008278401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$80.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.93
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
|
|
ASSAY IGA/IGD/IGG/IGM EACH
|
Professional
|
Both
|
$96.16
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3008278401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna of VT Commercial |
$90.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.89
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$11.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare VA CCN |
$9.30
|
|
|
ASSAY IGA/IGD/IGG/IGM EACH
|
Facility
|
OP
|
$96.16
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3008278401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna of VT Commercial |
$91.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$42.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$57.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$77.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$76.45
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cash Price |
$48.08
|
| Rate for Payer: Cigna Commercial |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$76.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$76.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$43.27
|
| Rate for Payer: Multiplan Commercial |
$89.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$43.27
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare VA CCN |
$43.27
|
|
|
ASSAY NEPHELOMETRY NOT SPEC
|
Facility
|
OP
|
$223.34
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
3008388301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna of VT Commercial |
$212.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$98.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$189.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.56
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cigna Commercial |
$178.67
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$207.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.50
|
| Rate for Payer: United Healthcare Commercial |
$212.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare VA CCN |
$100.50
|
|
