|
ASSAY OF PHENOBARBITAL
|
Professional
|
Both
|
$146.83
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
3008018401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$138.02 |
| Rate for Payer: Aetna of VT Commercial |
$138.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$75.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$75.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.16
|
| Rate for Payer: Cash Price |
$73.42
|
| Rate for Payer: Cash Price |
$73.42
|
| Rate for Payer: Cigna Commercial |
$18.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$136.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$23.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare VA CCN |
$15.30
|
|
|
ASSAY OF PHENYTOIN FREE
|
Professional
|
Both
|
$204.22
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
3008018601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$191.97 |
| Rate for Payer: Aetna of VT Commercial |
$191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.52
|
| Rate for Payer: Cash Price |
$102.11
|
| Rate for Payer: Cash Price |
$102.11
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$189.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.76
|
| Rate for Payer: United Healthcare Commercial |
$21.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: United Healthcare VA CCN |
$13.76
|
|
|
ASSAY OF PHENYTOIN FREE
|
Facility
|
IP
|
$204.22
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
3008018601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$194.01 |
| Rate for Payer: Aetna of VT Commercial |
$194.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.38
|
| Rate for Payer: Cash Price |
$102.11
|
| Rate for Payer: Cigna Commercial |
$163.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.38
|
| Rate for Payer: Multiplan Commercial |
$189.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.59
|
| Rate for Payer: United Healthcare Commercial |
$194.01
|
|
|
ASSAY OF PHENYTOIN FREE
|
Facility
|
OP
|
$204.22
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
3008018601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$194.01 |
| Rate for Payer: Aetna of VT Commercial |
$194.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.35
|
| Rate for Payer: Cash Price |
$102.11
|
| Rate for Payer: Cash Price |
$102.11
|
| Rate for Payer: Cigna Commercial |
$163.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.90
|
| Rate for Payer: Multiplan Commercial |
$189.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.90
|
| Rate for Payer: United Healthcare Commercial |
$194.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: United Healthcare VA CCN |
$91.90
|
|
|
ASSAY OF PHENYTOIN TOTAL
|
Facility
|
IP
|
$219.10
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
3008018501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.16 |
| Max. Negotiated Rate |
$208.15 |
| Rate for Payer: Aetna of VT Commercial |
$208.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.28
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cigna Commercial |
$175.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.28
|
| Rate for Payer: Multiplan Commercial |
$203.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.24
|
| Rate for Payer: United Healthcare Commercial |
$208.15
|
|
|
ASSAY OF PHENYTOIN TOTAL
|
Facility
|
OP
|
$219.10
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
3008018501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$208.15 |
| Rate for Payer: Aetna of VT Commercial |
$208.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$131.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.18
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cigna Commercial |
$175.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.28
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.28
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.59
|
| Rate for Payer: Multiplan Commercial |
$203.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.59
|
| Rate for Payer: United Healthcare Commercial |
$208.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$98.59
|
|
|
ASSAY OF PHENYTOIN TOTAL
|
Professional
|
Both
|
$219.10
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
3008018501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$205.95 |
| Rate for Payer: Aetna of VT Commercial |
$205.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.65
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cash Price |
$109.55
|
| Rate for Payer: Cigna Commercial |
$15.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.06
|
| Rate for Payer: Multiplan Commercial |
$203.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$20.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare VA CCN |
$13.25
|
|
|
ASSAY OF PHOSPHATASE ALKALINE
|
Facility
|
OP
|
$74.71
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
3008407501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$70.97 |
| Rate for Payer: Aetna of VT Commercial |
$70.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$60.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.39
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna Commercial |
$59.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.62
|
| Rate for Payer: Multiplan Commercial |
$69.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.62
|
| Rate for Payer: United Healthcare Commercial |
$70.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$33.62
|
|
|
ASSAY OF PHOSPHATASE ALKALINE
|
Facility
|
IP
|
$74.71
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
3008407501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.29 |
| Max. Negotiated Rate |
$70.97 |
| Rate for Payer: Aetna of VT Commercial |
$70.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.77
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna Commercial |
$59.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$59.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$69.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$63.50
|
| Rate for Payer: United Healthcare Commercial |
$70.97
|
|
|
ASSAY OF PHOSPHATASE ALKALINE
|
Professional
|
Both
|
$74.71
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
3008407501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna of VT Commercial |
$70.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.86
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.11
|
| Rate for Payer: Multiplan Commercial |
$69.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$7.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare VA CCN |
$5.18
|
|
|
ASSAY OF PHOSPHORUS INORGANIC
|
Facility
|
IP
|
$70.31
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
3008410001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$66.79 |
| Rate for Payer: Aetna of VT Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.25
|
| Rate for Payer: Cash Price |
$35.16
|
| Rate for Payer: Cigna Commercial |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$65.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.76
|
| Rate for Payer: United Healthcare Commercial |
$66.79
|
|
|
ASSAY OF PHOSPHORUS INORGANIC
|
Facility
|
OP
|
$70.31
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
3008410001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$66.79 |
| Rate for Payer: Aetna of VT Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.90
|
| Rate for Payer: Cash Price |
$35.16
|
| Rate for Payer: Cash Price |
$35.16
|
| Rate for Payer: Cigna Commercial |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.64
|
| Rate for Payer: Multiplan Commercial |
$65.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.64
|
| Rate for Payer: United Healthcare Commercial |
$66.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.74
|
| Rate for Payer: United Healthcare VA CCN |
$31.64
|
|
|
ASSAY OF PORPHOBILINOGEN
|
Professional
|
Both
|
$82.98
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3008411001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of VT Commercial |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$41.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$41.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.31
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.32
|
| Rate for Payer: Multiplan Commercial |
$77.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$12.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare VA CCN |
$8.44
|
|
|
ASSAY OF PORPHOBILINOGEN
|
Facility
|
IP
|
$82.98
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3008411001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$78.83 |
| Rate for Payer: Aetna of VT Commercial |
$78.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.38
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.38
|
| Rate for Payer: Multiplan Commercial |
$77.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.53
|
| Rate for Payer: United Healthcare Commercial |
$78.83
|
|
|
ASSAY OF PORPHOBILINOGEN
|
Facility
|
OP
|
$82.98
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3008411001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$78.83 |
| Rate for Payer: Aetna of VT Commercial |
$78.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$41.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$41.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.97
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.34
|
| Rate for Payer: Multiplan Commercial |
$77.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.34
|
| Rate for Payer: United Healthcare Commercial |
$78.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare VA CCN |
$37.34
|
|
|
ASSAY OF PREALBUMIN
|
Facility
|
IP
|
$159.24
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
3008413401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$127.39
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
|
|
ASSAY OF PREALBUMIN
|
Facility
|
OP
|
$159.24
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
3008413401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna of VT Commercial |
$151.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$70.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$95.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$126.60
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$127.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$127.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$135.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare Commercial |
$151.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.59
|
| Rate for Payer: United Healthcare VA CCN |
$71.66
|
|
|
ASSAY OF PREALBUMIN
|
Professional
|
Both
|
$159.24
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
3008413401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$149.69 |
| Rate for Payer: Aetna of VT Commercial |
$149.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.93
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.59
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.59
|
| Rate for Payer: United Healthcare VA CCN |
$14.59
|
|
|
ASSAY OF PREGNENOLONE
|
Professional
|
Both
|
$196.13
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
3008414001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$184.36 |
| Rate for Payer: Aetna of VT Commercial |
$184.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.33
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cigna Commercial |
$24.99
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.38
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare VA CCN |
$20.67
|
|
|
ASSAY OF PREGNENOLONE
|
Facility
|
OP
|
$196.13
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
3008414001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$186.32 |
| Rate for Payer: Aetna of VT Commercial |
$186.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$101.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$101.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.92
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cigna Commercial |
$156.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.26
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.26
|
| Rate for Payer: United Healthcare Commercial |
$186.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare VA CCN |
$88.26
|
|
|
ASSAY OF PREGNENOLONE
|
Facility
|
IP
|
$196.13
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
3008414001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$186.32 |
| Rate for Payer: Aetna of VT Commercial |
$186.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$145.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$145.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$166.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$164.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.90
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cigna Commercial |
$156.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.90
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$166.71
|
| Rate for Payer: United Healthcare Commercial |
$186.32
|
|
|
ASSAY OF PROGESTERONE
|
Facility
|
IP
|
$296.78
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
3008414401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.65 |
| Max. Negotiated Rate |
$281.94 |
| Rate for Payer: Aetna of VT Commercial |
$281.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$252.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$237.42
|
| Rate for Payer: Cash Price |
$148.39
|
| Rate for Payer: Cigna Commercial |
$237.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.42
|
| Rate for Payer: Multiplan Commercial |
$276.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.26
|
| Rate for Payer: United Healthcare Commercial |
$281.94
|
|
|
ASSAY OF PROGESTERONE
|
Professional
|
Both
|
$296.78
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
3008414401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$278.97 |
| Rate for Payer: Aetna of VT Commercial |
$278.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.66
|
| Rate for Payer: Cash Price |
$148.39
|
| Rate for Payer: Cash Price |
$148.39
|
| Rate for Payer: Cigna Commercial |
$25.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.57
|
| Rate for Payer: Multiplan Commercial |
$276.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.86
|
| Rate for Payer: United Healthcare Commercial |
$32.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.86
|
| Rate for Payer: United Healthcare VA CCN |
$20.86
|
|
|
ASSAY OF PROGESTERONE
|
Facility
|
OP
|
$296.78
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
3008414401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$281.94 |
| Rate for Payer: Aetna of VT Commercial |
$281.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$252.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$240.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.94
|
| Rate for Payer: Cash Price |
$148.39
|
| Rate for Payer: Cash Price |
$148.39
|
| Rate for Payer: Cigna Commercial |
$237.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$237.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$237.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.55
|
| Rate for Payer: Multiplan Commercial |
$276.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.55
|
| Rate for Payer: United Healthcare Commercial |
$281.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.86
|
| Rate for Payer: United Healthcare VA CCN |
$133.55
|
|
|
ASSAY OF PROINSULIN
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
3008420601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.69 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna of VT Commercial |
$328.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$131.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$153.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$131.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$208.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$275.07
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$276.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$276.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$155.70
|
| Rate for Payer: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$155.70
|
| Rate for Payer: United Healthcare Commercial |
$328.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.69
|
| Rate for Payer: United Healthcare VA CCN |
$155.70
|
|
