|
MEDICAL TESTIMONY
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 99075
|
| Hospital Charge Code |
9829907501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna of VT Commercial |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.60
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$137.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$137.60
|
| Rate for Payer: Multiplan Commercial |
$159.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.20
|
| Rate for Payer: United Healthcare Commercial |
$163.40
|
|
|
MED NUTRITION INDIV SUBSEQ
|
Facility
|
OP
|
$53.77
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
9429780301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna of VT Commercial |
$51.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.75
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cigna Commercial |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$50.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.20
|
| Rate for Payer: United Healthcare Commercial |
$51.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.20
|
| Rate for Payer: United Healthcare VA CCN |
$24.20
|
|
|
MED NUTRITION INDIV SUBSEQ
|
Facility
|
IP
|
$53.77
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
9429780301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna of VT Commercial |
$51.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.02
|
| Rate for Payer: Cash Price |
$26.89
|
| Rate for Payer: Cigna Commercial |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.02
|
| Rate for Payer: Multiplan Commercial |
$50.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.70
|
| Rate for Payer: United Healthcare Commercial |
$51.08
|
|
|
MEDROXYPROGESTERONE 150 MG/ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
636J105001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
|
|
MEDROXYPROGESTERONE 150 MG/ML
|
Professional
|
Both
|
$88.15
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
636J105001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$82.86 |
| Rate for Payer: Aetna of VT Commercial |
$82.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$81.98
|
| Rate for Payer: United Healthcare Commercial |
$74.93
|
| Rate for Payer: United Healthcare VA CCN |
$1.00
|
|
|
MEGESTROL 400 MG/10 ML SUSP
|
Facility
|
IP
|
$8.10
|
|
| Hospital Charge Code |
2500000188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna of VT Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.48
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna Commercial |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.88
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
|
|
MEGESTROL 400 MG/10 ML SUSP
|
Facility
|
OP
|
$8.10
|
|
| Hospital Charge Code |
2500000188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna of VT Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.44
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna Commercial |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.65
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.65
|
| Rate for Payer: United Healthcare VA CCN |
$3.65
|
|
|
MEGESTROL 400 MG/10 ML SUSP
|
Facility
|
OP
|
$8.10
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
636J899901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna of VT Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$7.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.44
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna Commercial |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.65
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.88
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.65
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.65
|
| Rate for Payer: United Healthcare VA CCN |
$3.65
|
|
|
MEGESTROL 400 MG/10 ML SUSP
|
Facility
|
IP
|
$8.10
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
636J899901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna of VT Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.48
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna Commercial |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.88
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
|
|
MEPITEL 3"X4"
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS A6206
|
| Hospital Charge Code |
2720075201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of VT Commercial |
$24.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.39
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna Commercial |
$20.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare VA CCN |
$11.54
|
|
|
MEPITEL 3"X4"
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
HCPCS A6206
|
| Hospital Charge Code |
2720075201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of VT Commercial |
$24.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.52
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna Commercial |
$20.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.80
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
|
|
MERCURY BLOOD
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3008382502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$80.12 |
| Rate for Payer: Aetna of VT Commercial |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.88
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna Commercial |
$11.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$13.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.72
|
| Rate for Payer: United Healthcare Commercial |
$14.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare VA CCN |
$6.72
|
|
|
MERCURY BLOOD
|
Professional
|
Both
|
$14.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3008382502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$80.12 |
| Rate for Payer: Aetna of VT Commercial |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.70
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna Commercial |
$19.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.03
|
| Rate for Payer: Multiplan Commercial |
$13.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$25.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare VA CCN |
$16.26
|
|
|
MERCURY BLOOD
|
Facility
|
IP
|
$14.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3008382502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna of VT Commercial |
$14.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.95
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna Commercial |
$11.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.95
|
| Rate for Payer: Multiplan Commercial |
$13.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.70
|
| Rate for Payer: United Healthcare Commercial |
$14.19
|
|
|
METABOLIC PANEL TOTAL CA
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
3008004801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$83.17 |
| Rate for Payer: Aetna of VT Commercial |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.60
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.40
|
| Rate for Payer: United Healthcare Commercial |
$83.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.46
|
| Rate for Payer: United Healthcare VA CCN |
$39.40
|
|
|
METABOLIC PANEL TOTAL CA
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
3008004801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$83.17 |
| Rate for Payer: Aetna of VT Commercial |
$83.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.04
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.04
|
| Rate for Payer: Multiplan Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.42
|
| Rate for Payer: United Healthcare Commercial |
$83.17
|
|
|
METABOLIC PANEL TOTAL CA
|
Professional
|
Both
|
$87.55
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
3008004801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$82.30 |
| Rate for Payer: Aetna of VT Commercial |
$82.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$41.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.64
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$81.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.46
|
| Rate for Payer: United Healthcare Commercial |
$13.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.46
|
| Rate for Payer: United Healthcare VA CCN |
$8.46
|
|
|
METANEPHRINES
|
Professional
|
Both
|
$180.95
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
3008383501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$170.09 |
| Rate for Payer: Aetna of VT Commercial |
$170.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.95
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cigna Commercial |
$20.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$168.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$26.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare VA CCN |
$16.94
|
|
|
METANEPHRINES
|
Facility
|
OP
|
$180.95
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
3008383501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of VT Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$80.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$146.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$81.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.86
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cigna Commercial |
$144.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$81.43
|
| Rate for Payer: Multiplan Commercial |
$168.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.43
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare VA CCN |
$81.43
|
|
|
METANEPHRINES
|
Facility
|
IP
|
$180.95
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
3008383501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.92 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of VT Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.76
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cigna Commercial |
$144.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.76
|
| Rate for Payer: Multiplan Commercial |
$168.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.81
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
METHACHOLINE CHLORIDE, NEB
|
Facility
|
OP
|
$512.71
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
636J767401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$487.07 |
| Rate for Payer: Aetna of VT Commercial |
$487.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$227.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$415.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$230.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.60
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cigna Commercial |
$410.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$410.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$410.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$230.72
|
| Rate for Payer: Multiplan Commercial |
$476.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$230.72
|
| Rate for Payer: United Healthcare Commercial |
$487.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.72
|
| Rate for Payer: United Healthcare VA CCN |
$230.72
|
|
|
METHACHOLINE CHLORIDE, NEB
|
Facility
|
IP
|
$512.71
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
636J767401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$379.46 |
| Max. Negotiated Rate |
$487.07 |
| Rate for Payer: Aetna of VT Commercial |
$487.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$379.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$435.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.17
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cigna Commercial |
$410.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$410.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$410.17
|
| Rate for Payer: Multiplan Commercial |
$476.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.80
|
| Rate for Payer: United Healthcare Commercial |
$487.07
|
|
|
METHYLENEDIOXYAMPHETAMINES
|
Facility
|
OP
|
$47.82
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
3008035901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$45.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$38.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.02
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.52
|
| Rate for Payer: Multiplan Commercial |
$44.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.52
|
| Rate for Payer: United Healthcare Commercial |
$45.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.52
|
| Rate for Payer: United Healthcare VA CCN |
$21.52
|
|
|
METHYLENEDIOXYAMPHETAMINES
|
Facility
|
IP
|
$47.82
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
3008035901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$45.43 |
| Rate for Payer: Aetna of VT Commercial |
$45.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$38.26
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$38.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$38.26
|
| Rate for Payer: Multiplan Commercial |
$44.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.65
|
| Rate for Payer: United Healthcare Commercial |
$45.43
|
|
|
METHYLENEDIOXYAMPHETAMINES
|
Professional
|
Both
|
$47.82
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
3008035901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna of VT Commercial |
$44.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cash Price |
$23.91
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.12
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.12
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.87
|
| Rate for Payer: Multiplan Commercial |
$44.47
|
| Rate for Payer: United Healthcare Commercial |
$40.65
|
| Rate for Payer: United Healthcare VA CCN |
$19.13
|
|
