|
ASSAY OF CHROMIUM
|
Facility
|
IP
|
$289.52
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
3008249501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.27 |
| Max. Negotiated Rate |
$275.04 |
| Rate for Payer: Aetna of VT Commercial |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.62
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cigna Commercial |
$231.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.62
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.09
|
| Rate for Payer: United Healthcare Commercial |
$275.04
|
|
|
ASSAY OF CHROMIUM
|
Professional
|
Both
|
$289.52
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
3008249501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$272.15 |
| Rate for Payer: Aetna of VT Commercial |
$272.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.66
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cigna Commercial |
$24.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.28
|
| Rate for Payer: United Healthcare Commercial |
$31.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.28
|
| Rate for Payer: United Healthcare VA CCN |
$20.28
|
|
|
ASSAY OF CHROMIUM
|
Facility
|
OP
|
$289.52
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
3008249501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$275.04 |
| Rate for Payer: Aetna of VT Commercial |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$174.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.17
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Cigna Commercial |
$231.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.28
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.28
|
| Rate for Payer: United Healthcare Commercial |
$275.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.28
|
| Rate for Payer: United Healthcare VA CCN |
$130.28
|
|
|
ASSAY OF COPPER
|
Facility
|
OP
|
$160.71
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3008252501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Aetna of VT Commercial |
$152.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$130.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$72.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.76
|
| Rate for Payer: Cash Price |
$80.36
|
| Rate for Payer: Cash Price |
$80.36
|
| Rate for Payer: Cigna Commercial |
$128.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.32
|
| Rate for Payer: Multiplan Commercial |
$149.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.32
|
| Rate for Payer: United Healthcare Commercial |
$152.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: United Healthcare VA CCN |
$72.32
|
|
|
ASSAY OF COPPER
|
Facility
|
IP
|
$160.71
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3008252501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Aetna of VT Commercial |
$152.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$136.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.57
|
| Rate for Payer: Cash Price |
$80.36
|
| Rate for Payer: Cigna Commercial |
$128.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$128.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$128.57
|
| Rate for Payer: Multiplan Commercial |
$149.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$136.60
|
| Rate for Payer: United Healthcare Commercial |
$152.67
|
|
|
ASSAY OF COPPER
|
Professional
|
Both
|
$160.71
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
3008252501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$151.07 |
| Rate for Payer: Aetna of VT Commercial |
$151.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.20
|
| Rate for Payer: Cash Price |
$80.36
|
| Rate for Payer: Cash Price |
$80.36
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$149.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: United Healthcare VA CCN |
$12.41
|
|
|
ASSAY OF C-PEPTIDE
|
Professional
|
Both
|
$289.61
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
3008468101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$272.23 |
| Rate for Payer: Aetna of VT Commercial |
$272.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.57
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna Commercial |
$25.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$269.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare Commercial |
$32.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare VA CCN |
$20.81
|
|
|
ASSAY OF C-PEPTIDE
|
Facility
|
OP
|
$289.61
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
3008468101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$275.13 |
| Rate for Payer: Aetna of VT Commercial |
$275.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$128.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$174.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$234.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$130.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$230.24
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna Commercial |
$231.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$130.32
|
| Rate for Payer: Multiplan Commercial |
$269.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.32
|
| Rate for Payer: United Healthcare Commercial |
$275.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare VA CCN |
$130.32
|
|
|
ASSAY OF C-PEPTIDE
|
Facility
|
IP
|
$289.61
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
3008468101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.34 |
| Max. Negotiated Rate |
$275.13 |
| Rate for Payer: Aetna of VT Commercial |
$275.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$214.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$231.69
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cigna Commercial |
$231.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$231.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$231.69
|
| Rate for Payer: Multiplan Commercial |
$269.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$246.17
|
| Rate for Payer: United Healthcare Commercial |
$275.13
|
|
|
ASSAY OF CREATININE
|
Facility
|
OP
|
$50.05
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3008256501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$47.55 |
| Rate for Payer: Aetna of VT Commercial |
$47.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.79
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cigna Commercial |
$40.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.52
|
| Rate for Payer: Multiplan Commercial |
$46.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.52
|
| Rate for Payer: United Healthcare Commercial |
$47.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.12
|
| Rate for Payer: United Healthcare VA CCN |
$22.52
|
|
|
ASSAY OF CREATININE
|
Facility
|
IP
|
$50.05
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
3008256501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$47.55 |
| Rate for Payer: Aetna of VT Commercial |
$47.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.04
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cigna Commercial |
$40.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.04
|
| Rate for Payer: Multiplan Commercial |
$46.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.54
|
| Rate for Payer: United Healthcare Commercial |
$47.55
|
|
|
ASSAY OF DIGOXIN TOTAL
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
3008016201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$167.38 |
| Rate for Payer: Aetna of VT Commercial |
$167.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$78.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$106.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.07
|
| Rate for Payer: Cash Price |
$88.10
|
| Rate for Payer: Cash Price |
$88.10
|
| Rate for Payer: Cigna Commercial |
$140.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.29
|
| Rate for Payer: Multiplan Commercial |
$163.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.29
|
| Rate for Payer: United Healthcare Commercial |
$167.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.28
|
| Rate for Payer: United Healthcare VA CCN |
$79.29
|
|
|
ASSAY OF DIGOXIN TOTAL
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
3008016201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$167.38 |
| Rate for Payer: Aetna of VT Commercial |
$167.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$148.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.95
|
| Rate for Payer: Cash Price |
$88.10
|
| Rate for Payer: Cigna Commercial |
$140.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.95
|
| Rate for Payer: Multiplan Commercial |
$163.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.76
|
| Rate for Payer: United Healthcare Commercial |
$167.38
|
|
|
ASSAY OF ERYTHROPOIETIN
|
Facility
|
IP
|
$249.61
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
3008266801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.74 |
| Max. Negotiated Rate |
$237.13 |
| Rate for Payer: Aetna of VT Commercial |
$237.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$184.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$184.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$199.69
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cigna Commercial |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.69
|
| Rate for Payer: Multiplan Commercial |
$232.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.17
|
| Rate for Payer: United Healthcare Commercial |
$237.13
|
|
|
ASSAY OF ERYTHROPOIETIN
|
Facility
|
OP
|
$249.61
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
3008266801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$237.13 |
| Rate for Payer: Aetna of VT Commercial |
$237.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.44
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cigna Commercial |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$199.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$199.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$232.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.17
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.32
|
| Rate for Payer: United Healthcare Commercial |
$237.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare VA CCN |
$112.32
|
|
|
ASSAY OF ERYTHROPOIETIN
|
Professional
|
Both
|
$249.61
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
3008266801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$234.63 |
| Rate for Payer: Aetna of VT Commercial |
$234.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.12
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cash Price |
$124.81
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$232.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.79
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare Commercial |
$28.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare VA CCN |
$18.79
|
|
|
ASSAY OF ESTROGENS
|
Facility
|
OP
|
$125.25
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3008267101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna of VT Commercial |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$56.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.57
|
| Rate for Payer: Cash Price |
$62.62
|
| Rate for Payer: Cash Price |
$62.62
|
| Rate for Payer: Cigna Commercial |
$100.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$56.36
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$56.36
|
| Rate for Payer: United Healthcare Commercial |
$118.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.30
|
| Rate for Payer: United Healthcare VA CCN |
$56.36
|
|
|
ASSAY OF ESTROGENS
|
Professional
|
Both
|
$125.25
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3008267101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna of VT Commercial |
$117.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.22
|
| Rate for Payer: Cash Price |
$62.62
|
| Rate for Payer: Cash Price |
$62.62
|
| Rate for Payer: Cigna Commercial |
$39.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$32.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$32.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.85
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$32.30
|
| Rate for Payer: United Healthcare Commercial |
$49.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.30
|
| Rate for Payer: United Healthcare VA CCN |
$32.30
|
|
|
ASSAY OF ESTROGENS
|
Facility
|
IP
|
$125.25
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3008267101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$118.99 |
| Rate for Payer: Aetna of VT Commercial |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$106.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$105.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$100.20
|
| Rate for Payer: Cash Price |
$62.62
|
| Rate for Payer: Cigna Commercial |
$100.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$100.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$100.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$106.46
|
| Rate for Payer: United Healthcare Commercial |
$118.99
|
|
|
ASSAY OF ETHOSUXIMIDE
|
Facility
|
IP
|
$185.18
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
3008016801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.05 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna of VT Commercial |
$175.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$155.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$148.14
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cigna Commercial |
$148.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.14
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.40
|
| Rate for Payer: United Healthcare Commercial |
$175.92
|
|
|
ASSAY OF ETHOSUXIMIDE
|
Professional
|
Both
|
$185.18
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
3008016801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Aetna of VT Commercial |
$174.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.92
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cigna Commercial |
$19.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.11
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$25.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.34
|
| Rate for Payer: United Healthcare VA CCN |
$16.34
|
|
|
ASSAY OF ETHOSUXIMIDE
|
Facility
|
OP
|
$185.18
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
3008016801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna of VT Commercial |
$175.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$157.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.22
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cigna Commercial |
$148.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$83.33
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$83.33
|
| Rate for Payer: United Healthcare Commercial |
$175.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.34
|
| Rate for Payer: United Healthcare VA CCN |
$83.33
|
|
|
ASSAY OF FERRITIN
|
Facility
|
IP
|
$122.43
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
3008272801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.61 |
| Max. Negotiated Rate |
$116.31 |
| Rate for Payer: Aetna of VT Commercial |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.94
|
| Rate for Payer: Cash Price |
$61.22
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.94
|
| Rate for Payer: Multiplan Commercial |
$113.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.07
|
| Rate for Payer: United Healthcare Commercial |
$116.31
|
|
|
ASSAY OF FERRITIN
|
Facility
|
OP
|
$122.43
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
3008272801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$116.31 |
| Rate for Payer: Aetna of VT Commercial |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.33
|
| Rate for Payer: Cash Price |
$61.22
|
| Rate for Payer: Cash Price |
$61.22
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.09
|
| Rate for Payer: Multiplan Commercial |
$113.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.09
|
| Rate for Payer: United Healthcare Commercial |
$116.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.63
|
| Rate for Payer: United Healthcare VA CCN |
$55.09
|
|
|
ASSAY OF FETAL FIBRONECTIN
|
Professional
|
Both
|
$686.48
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
3008273101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.51 |
| Max. Negotiated Rate |
$645.29 |
| Rate for Payer: Aetna of VT Commercial |
$645.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$317.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$317.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.08
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cigna Commercial |
$78.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.51
|
| Rate for Payer: Multiplan Commercial |
$638.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$99.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare VA CCN |
$64.41
|
|
