|
ASSAY OF GONADOTROPIN (FSH)
|
Professional
|
Both
|
$141.49
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
3008300101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of VT Commercial |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.76
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.32
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$28.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: United Healthcare VA CCN |
$18.58
|
|
|
ASSAY OF GONADOTROPIN (FSH)
|
Facility
|
IP
|
$141.49
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
3008300101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna of VT Commercial |
$134.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.19
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.19
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.27
|
| Rate for Payer: United Healthcare Commercial |
$134.42
|
|
|
ASSAY OF GONADOTROPIN (FSH)
|
Facility
|
OP
|
$141.49
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
3008300101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$134.42 |
| Rate for Payer: Aetna of VT Commercial |
$134.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.48
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cigna Commercial |
$113.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.67
|
| Rate for Payer: Multiplan Commercial |
$131.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.67
|
| Rate for Payer: United Healthcare Commercial |
$134.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: United Healthcare VA CCN |
$63.67
|
|
|
ASSAY OF GONADOTROPIN (LH)
|
Facility
|
IP
|
$175.88
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
3008300201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna of VT Commercial |
$167.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.70
|
| Rate for Payer: Cash Price |
$87.94
|
| Rate for Payer: Cigna Commercial |
$140.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.70
|
| Rate for Payer: Multiplan Commercial |
$163.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.50
|
| Rate for Payer: United Healthcare Commercial |
$167.09
|
|
|
ASSAY OF GONADOTROPIN (LH)
|
Professional
|
Both
|
$175.88
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
3008300201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$165.33 |
| Rate for Payer: Aetna of VT Commercial |
$165.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.65
|
| Rate for Payer: Cash Price |
$87.94
|
| Rate for Payer: Cash Price |
$87.94
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$163.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare Commercial |
$28.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare VA CCN |
$18.52
|
|
|
ASSAY OF GONADOTROPIN (LH)
|
Facility
|
OP
|
$175.88
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
3008300201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna of VT Commercial |
$167.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.82
|
| Rate for Payer: Cash Price |
$87.94
|
| Rate for Payer: Cash Price |
$87.94
|
| Rate for Payer: Cigna Commercial |
$140.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.15
|
| Rate for Payer: Multiplan Commercial |
$163.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.15
|
| Rate for Payer: United Healthcare Commercial |
$167.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare VA CCN |
$79.15
|
|
|
ASSAY OF HAPTOGLOBIN QUANT
|
Facility
|
IP
|
$93.58
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
3008301001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.26 |
| Max. Negotiated Rate |
$88.90 |
| Rate for Payer: Aetna of VT Commercial |
$88.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.86
|
| Rate for Payer: Cash Price |
$46.79
|
| Rate for Payer: Cigna Commercial |
$74.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.86
|
| Rate for Payer: Multiplan Commercial |
$87.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.54
|
| Rate for Payer: United Healthcare Commercial |
$88.90
|
|
|
ASSAY OF HAPTOGLOBIN QUANT
|
Facility
|
OP
|
$93.58
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
3008301001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$88.90 |
| Rate for Payer: Aetna of VT Commercial |
$88.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$41.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$56.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$79.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$75.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$74.40
|
| Rate for Payer: Cash Price |
$46.79
|
| Rate for Payer: Cash Price |
$46.79
|
| Rate for Payer: Cigna Commercial |
$74.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$74.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$74.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$42.11
|
| Rate for Payer: Multiplan Commercial |
$87.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$79.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$42.11
|
| Rate for Payer: United Healthcare Commercial |
$88.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare VA CCN |
$42.11
|
|
|
ASSAY OF HAPTOGLOBIN QUANT
|
Professional
|
Both
|
$93.58
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
3008301001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$87.97 |
| Rate for Payer: Aetna of VT Commercial |
$87.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.50
|
| Rate for Payer: Cash Price |
$46.79
|
| Rate for Payer: Cash Price |
$46.79
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$87.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare Commercial |
$19.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare VA CCN |
$12.58
|
|
|
ASSAY OF HOMOCYSTEINE
|
Facility
|
OP
|
$241.44
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
3008309001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$229.37 |
| Rate for Payer: Aetna of VT Commercial |
$229.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$205.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$108.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$191.94
|
| Rate for Payer: Cash Price |
$120.72
|
| Rate for Payer: Cash Price |
$120.72
|
| Rate for Payer: Cigna Commercial |
$193.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$193.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$193.15
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.65
|
| Rate for Payer: Multiplan Commercial |
$224.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$108.65
|
| Rate for Payer: United Healthcare Commercial |
$229.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare VA CCN |
$108.65
|
|
|
ASSAY OF HOMOCYSTEINE
|
Facility
|
IP
|
$241.44
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
3008309001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.69 |
| Max. Negotiated Rate |
$229.37 |
| Rate for Payer: Aetna of VT Commercial |
$229.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$178.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$178.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$205.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.15
|
| Rate for Payer: Cash Price |
$120.72
|
| Rate for Payer: Cigna Commercial |
$193.15
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$193.15
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$193.15
|
| Rate for Payer: Multiplan Commercial |
$224.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$205.22
|
| Rate for Payer: United Healthcare Commercial |
$229.37
|
|
|
ASSAY OF HOMOCYSTEINE
|
Professional
|
Both
|
$241.44
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
3008309001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$226.95 |
| Rate for Payer: Aetna of VT Commercial |
$226.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.63
|
| Rate for Payer: Cash Price |
$120.72
|
| Rate for Payer: Cash Price |
$120.72
|
| Rate for Payer: Cigna Commercial |
$21.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$224.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare Commercial |
$27.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare VA CCN |
$17.92
|
|
|
ASSAY OF INSULIN TOTAL
|
Facility
|
IP
|
$138.56
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
3008352501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$131.63 |
| Rate for Payer: Aetna of VT Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.85
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.85
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.78
|
| Rate for Payer: United Healthcare Commercial |
$131.63
|
|
|
ASSAY OF INSULIN TOTAL
|
Facility
|
OP
|
$138.56
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
3008352501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$131.63 |
| Rate for Payer: Aetna of VT Commercial |
$131.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.16
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.35
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.35
|
| Rate for Payer: United Healthcare Commercial |
$131.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare VA CCN |
$62.35
|
|
|
ASSAY OF INSULIN TOTAL
|
Professional
|
Both
|
$138.56
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
3008352501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$130.25 |
| Rate for Payer: Aetna of VT Commercial |
$130.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.54
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.43
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.43
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.27
|
| Rate for Payer: Multiplan Commercial |
$128.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare VA CCN |
$11.43
|
|
|
ASSAY OF IRON
|
Facility
|
IP
|
$64.74
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
3008354001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Aetna of VT Commercial |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$47.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$47.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.79
|
| Rate for Payer: Cash Price |
$32.37
|
| Rate for Payer: Cigna Commercial |
$51.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.79
|
| Rate for Payer: Multiplan Commercial |
$60.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.03
|
| Rate for Payer: United Healthcare Commercial |
$61.50
|
|
|
ASSAY OF IRON
|
Facility
|
OP
|
$64.74
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
3008354001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Aetna of VT Commercial |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$38.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.47
|
| Rate for Payer: Cash Price |
$32.37
|
| Rate for Payer: Cash Price |
$32.37
|
| Rate for Payer: Cigna Commercial |
$51.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$51.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$51.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.13
|
| Rate for Payer: Multiplan Commercial |
$60.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.13
|
| Rate for Payer: United Healthcare Commercial |
$61.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare VA CCN |
$29.13
|
|
|
ASSAY OF L7383TRANSFERRIN
|
Professional
|
Both
|
$178.48
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
3008446601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$167.77 |
| Rate for Payer: Aetna of VT Commercial |
$167.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.82
|
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.58
|
| Rate for Payer: Multiplan Commercial |
$165.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare VA CCN |
$12.76
|
|
|
ASSAY OF L7383TRANSFERRIN
|
Facility
|
OP
|
$178.48
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
3008446601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$169.56 |
| Rate for Payer: Aetna of VT Commercial |
$169.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$141.89
|
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Cigna Commercial |
$142.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.32
|
| Rate for Payer: Multiplan Commercial |
$165.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.32
|
| Rate for Payer: United Healthcare Commercial |
$169.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare VA CCN |
$80.32
|
|
|
ASSAY OF L7383TRANSFERRIN
|
Facility
|
IP
|
$178.48
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
3008446601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$169.56 |
| Rate for Payer: Aetna of VT Commercial |
$169.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$151.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.78
|
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Cigna Commercial |
$142.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$142.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$142.78
|
| Rate for Payer: Multiplan Commercial |
$165.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.71
|
| Rate for Payer: United Healthcare Commercial |
$169.56
|
|
|
ASSAY OF LACTATE
|
Professional
|
Both
|
$141.66
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
3008360501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$133.16 |
| Rate for Payer: Aetna of VT Commercial |
$133.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.28
|
| Rate for Payer: Cash Price |
$70.83
|
| Rate for Payer: Cash Price |
$70.83
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.57
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.57
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.41
|
| Rate for Payer: Multiplan Commercial |
$131.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.57
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare Commercial |
$17.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare VA CCN |
$11.57
|
|
|
ASSAY OF LACTATE
|
Facility
|
IP
|
$141.66
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
3008360501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.84 |
| Max. Negotiated Rate |
$134.58 |
| Rate for Payer: Aetna of VT Commercial |
$134.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.33
|
| Rate for Payer: Cash Price |
$70.83
|
| Rate for Payer: Cigna Commercial |
$113.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.33
|
| Rate for Payer: Multiplan Commercial |
$131.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.41
|
| Rate for Payer: United Healthcare Commercial |
$134.58
|
|
|
ASSAY OF LACTATE
|
Facility
|
OP
|
$141.66
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
3008360501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$134.58 |
| Rate for Payer: Aetna of VT Commercial |
$134.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$120.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$112.62
|
| Rate for Payer: Cash Price |
$70.83
|
| Rate for Payer: Cash Price |
$70.83
|
| Rate for Payer: Cigna Commercial |
$113.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$113.33
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$113.33
|
| Rate for Payer: Martins Point Health Care Commercial |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$131.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$120.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$134.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare VA CCN |
$63.75
|
|
|
ASSAY OF LEAD
|
Facility
|
OP
|
$128.53
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3008365501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$122.10 |
| Rate for Payer: Aetna of VT Commercial |
$122.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$77.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$57.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$102.18
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cigna Commercial |
$102.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$102.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$102.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$119.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.84
|
| Rate for Payer: United Healthcare Commercial |
$122.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare VA CCN |
$57.84
|
|
|
ASSAY OF LEAD
|
Professional
|
Both
|
$128.53
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3008365501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$120.82 |
| Rate for Payer: Aetna of VT Commercial |
$120.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.70
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cigna Commercial |
$14.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.94
|
| Rate for Payer: Multiplan Commercial |
$119.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$18.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare VA CCN |
$12.11
|
|
