|
ASSAY OF FETAL FIBRONECTIN
|
Facility
|
OP
|
$686.48
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
3008273101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$652.16 |
| Rate for Payer: Aetna of VT Commercial |
$652.16
|
| 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 |
$304.04
|
| 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 |
$413.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$583.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$556.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$308.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$545.75
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cigna Commercial |
$549.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$549.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$549.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$308.92
|
| Rate for Payer: Multiplan Commercial |
$638.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$583.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$308.92
|
| Rate for Payer: United Healthcare Commercial |
$652.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare VA CCN |
$308.92
|
|
|
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
|
|
|
ASSAY OF FOLIC ACID SERUM
|
Facility
|
IP
|
$142.69
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
3008274601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$135.56 |
| Rate for Payer: Aetna of VT Commercial |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.15
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna Commercial |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.15
|
| Rate for Payer: Multiplan Commercial |
$132.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.29
|
| Rate for Payer: United Healthcare Commercial |
$135.56
|
|
|
ASSAY OF FOLIC ACID SERUM
|
Facility
|
OP
|
$142.69
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
3008274601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$135.56 |
| Rate for Payer: Aetna of VT Commercial |
$135.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.44
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cigna Commercial |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.21
|
| Rate for Payer: Multiplan Commercial |
$132.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.29
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.21
|
| Rate for Payer: United Healthcare Commercial |
$135.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.70
|
| Rate for Payer: United Healthcare VA CCN |
$64.21
|
|
|
ASSAY OF FREE TESTOSTERONE
|
Facility
|
IP
|
$208.07
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3008440201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.99 |
| Max. Negotiated Rate |
$197.67 |
| Rate for Payer: Aetna of VT Commercial |
$197.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.46
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna Commercial |
$166.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.46
|
| Rate for Payer: Multiplan Commercial |
$193.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.86
|
| Rate for Payer: United Healthcare Commercial |
$197.67
|
|
|
ASSAY OF FREE TESTOSTERONE
|
Professional
|
Both
|
$208.07
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3008440201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$195.59 |
| Rate for Payer: Aetna of VT Commercial |
$195.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.53
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna Commercial |
$30.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.11
|
| Rate for Payer: Multiplan Commercial |
$193.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$39.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: United Healthcare VA CCN |
$25.47
|
|
|
ASSAY OF FREE TESTOSTERONE
|
Facility
|
OP
|
$208.07
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
3008440201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$197.67 |
| Rate for Payer: Aetna of VT Commercial |
$197.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.42
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cash Price |
$104.03
|
| Rate for Payer: Cigna Commercial |
$166.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.63
|
| Rate for Payer: Multiplan Commercial |
$193.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.63
|
| Rate for Payer: United Healthcare Commercial |
$197.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: United Healthcare VA CCN |
$93.63
|
|
|
ASSAY OF FREE THYROXINE
|
Facility
|
IP
|
$134.42
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
3008443901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$107.54
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
|
|
ASSAY OF FREE THYROXINE
|
Facility
|
OP
|
$134.42
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
3008443901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Aetna of VT Commercial |
$127.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$114.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$108.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$60.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$106.86
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cigna Commercial |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$107.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$107.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.49
|
| Rate for Payer: Multiplan Commercial |
$125.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$60.49
|
| Rate for Payer: United Healthcare Commercial |
$127.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: United Healthcare VA CCN |
$60.49
|
|
|
ASSAY OF G6PD ENZYME
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
3008295501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$142.55 |
| Rate for Payer: Aetna of VT Commercial |
$142.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$66.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$90.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$67.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.29
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cigna Commercial |
$120.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.52
|
| Rate for Payer: Multiplan Commercial |
$139.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.52
|
| Rate for Payer: United Healthcare Commercial |
$142.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.70
|
| Rate for Payer: United Healthcare VA CCN |
$67.52
|
|
|
ASSAY OF G6PD ENZYME
|
Professional
|
Both
|
$150.05
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
3008295501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna of VT Commercial |
$141.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.58
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.56
|
| Rate for Payer: Multiplan Commercial |
$139.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.70
|
| Rate for Payer: United Healthcare Commercial |
$14.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.70
|
| Rate for Payer: United Healthcare VA CCN |
$9.70
|
|
|
ASSAY OF G6PD ENZYME
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
3008295501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.05 |
| Max. Negotiated Rate |
$142.55 |
| Rate for Payer: Aetna of VT Commercial |
$142.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$127.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$120.04
|
| Rate for Payer: Cash Price |
$75.03
|
| Rate for Payer: Cigna Commercial |
$120.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.04
|
| Rate for Payer: Multiplan Commercial |
$139.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.54
|
| Rate for Payer: United Healthcare Commercial |
$142.55
|
|
|
ASSAY OF GAMMAGLOBULIN IGE
|
Facility
|
OP
|
$115.29
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3008278501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna of VT Commercial |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$51.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.66
|
| Rate for Payer: Cash Price |
$57.65
|
| Rate for Payer: Cash Price |
$57.65
|
| Rate for Payer: Cigna Commercial |
$92.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.88
|
| Rate for Payer: Multiplan Commercial |
$107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.88
|
| Rate for Payer: United Healthcare Commercial |
$109.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare VA CCN |
$51.88
|
|
|
ASSAY OF GAMMAGLOBULIN IGE
|
Professional
|
Both
|
$115.29
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3008278501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$108.37 |
| Rate for Payer: Aetna of VT Commercial |
$108.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.14
|
| Rate for Payer: Cash Price |
$57.65
|
| Rate for Payer: Cash Price |
$57.65
|
| Rate for Payer: Cigna Commercial |
$19.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$25.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare VA CCN |
$16.46
|
|
|
ASSAY OF GAMMAGLOBULIN IGE
|
Facility
|
IP
|
$115.29
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3008278501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.33 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna of VT Commercial |
$109.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$98.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.23
|
| Rate for Payer: Cash Price |
$57.65
|
| Rate for Payer: Cigna Commercial |
$92.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.23
|
| Rate for Payer: Multiplan Commercial |
$107.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$109.53
|
|
|
ASSAY OF GENTAMICIN
|
Professional
|
Both
|
$167.51
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3008017001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$157.46 |
| Rate for Payer: Aetna of VT Commercial |
$157.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.00
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$19.83
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$25.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare VA CCN |
$16.38
|
|
|
ASSAY OF GENTAMICIN
|
Facility
|
OP
|
$167.51
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3008017001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna of VT Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$80.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$135.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.17
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.38
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.38
|
| Rate for Payer: United Healthcare Commercial |
$159.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare VA CCN |
$75.38
|
|
|
ASSAY OF GENTAMICIN
|
Facility
|
IP
|
$167.51
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
3008017001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$159.13 |
| Rate for Payer: Aetna of VT Commercial |
$159.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.01
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.01
|
| Rate for Payer: Multiplan Commercial |
$155.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.38
|
| Rate for Payer: United Healthcare Commercial |
$159.13
|
|
|
ASSAY OF GLUTAMYLTRASE GAMMA
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
3008297701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna of VT Commercial |
$95.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$12.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$12.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$12.30
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$8.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.20
|
| Rate for Payer: United Healthcare Commercial |
$11.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.20
|
| Rate for Payer: United Healthcare VA CCN |
$7.20
|
|
|
ASSAY OF GLUTAMYLTRASE GAMMA
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
3008297701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna of VT Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$35.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$35.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.09
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$45.90
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.20
|
| Rate for Payer: United Healthcare VA CCN |
$45.90
|
|
|
ASSAY OF GLUTAMYLTRASE GAMMA
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
3008297701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.49 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna of VT Commercial |
$96.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$81.60
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$81.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$94.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.70
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
|
|
ASSAY OF GLUTATHIONE
|
Facility
|
OP
|
$337.87
|
|
|
Service Code
|
CPT 82978
|
| Hospital Charge Code |
3008297801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$320.98 |
| Rate for Payer: Aetna of VT Commercial |
$320.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$273.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$268.61
|
| Rate for Payer: Cash Price |
$168.94
|
| Rate for Payer: Cash Price |
$168.94
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$152.04
|
| Rate for Payer: Multiplan Commercial |
$314.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$152.04
|
| Rate for Payer: United Healthcare Commercial |
$320.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.45
|
| Rate for Payer: United Healthcare VA CCN |
$152.04
|
|
|
ASSAY OF GLUTATHIONE
|
Facility
|
IP
|
$337.87
|
|
|
Service Code
|
CPT 82978
|
| Hospital Charge Code |
3008297801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$320.98 |
| Rate for Payer: Aetna of VT Commercial |
$320.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$287.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$283.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$270.30
|
| Rate for Payer: Cash Price |
$168.94
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$270.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$270.30
|
| Rate for Payer: Multiplan Commercial |
$314.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$287.19
|
| Rate for Payer: United Healthcare Commercial |
$320.98
|
|
|
ASSAY OF GLYCATED PROTEIN
|
Facility
|
OP
|
$163.37
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3008298501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Aetna of VT Commercial |
$155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$82.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$82.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$98.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$132.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.88
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cigna Commercial |
$130.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.52
|
| Rate for Payer: Multiplan Commercial |
$151.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.52
|
| Rate for Payer: United Healthcare Commercial |
$155.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare VA CCN |
$73.52
|
|
|
ASSAY OF GLYCATED PROTEIN
|
Facility
|
IP
|
$163.37
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
3008298501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Aetna of VT Commercial |
$155.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.70
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cigna Commercial |
$130.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$130.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$130.70
|
| Rate for Payer: Multiplan Commercial |
$151.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.86
|
| Rate for Payer: United Healthcare Commercial |
$155.20
|
|
