|
ASSAY OF PROINSULIN
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
3008420601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$256.07 |
| 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 |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$256.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$294.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$290.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$276.80
|
| 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: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.10
|
| Rate for Payer: United Healthcare Commercial |
$328.70
|
|
|
ASSAY OF PROINSULIN
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
3008420601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$325.24 |
| Rate for Payer: Aetna of VT Commercial |
$325.24
|
| 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 |
$27.49
|
| 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 |
$37.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.19
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cash Price |
$173.00
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$26.69
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$26.69
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.32
|
| Rate for Payer: Multiplan Commercial |
$321.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.69
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.69
|
| Rate for Payer: United Healthcare Commercial |
$41.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.69
|
| Rate for Payer: United Healthcare VA CCN |
$26.69
|
|
|
ASSAY OF PROLACTIN
|
Professional
|
Both
|
$147.74
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
3008414601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$138.88 |
| Rate for Payer: Aetna of VT Commercial |
$138.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$27.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.12
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna Commercial |
$23.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.11
|
| Rate for Payer: Multiplan Commercial |
$137.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.38
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.38
|
| Rate for Payer: United Healthcare VA CCN |
$19.38
|
|
|
ASSAY OF PROLACTIN
|
Facility
|
IP
|
$147.74
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
3008414601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna of VT Commercial |
$140.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.19
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna Commercial |
$118.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.19
|
| Rate for Payer: Multiplan Commercial |
$137.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.58
|
| Rate for Payer: United Healthcare Commercial |
$140.35
|
|
|
ASSAY OF PROLACTIN
|
Facility
|
OP
|
$147.74
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
3008414601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$140.35 |
| Rate for Payer: Aetna of VT Commercial |
$140.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$95.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$95.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$125.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$117.45
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cigna Commercial |
$118.19
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.48
|
| Rate for Payer: Multiplan Commercial |
$137.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$125.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.48
|
| Rate for Payer: United Healthcare Commercial |
$140.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.38
|
| Rate for Payer: United Healthcare VA CCN |
$66.48
|
|
|
ASSAY OF PROTEIN OTHER
|
Facility
|
IP
|
$65.44
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3008415701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.43 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Aetna of VT Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.35
|
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Cigna Commercial |
$52.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$60.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.62
|
| Rate for Payer: United Healthcare Commercial |
$62.17
|
|
|
ASSAY OF PROTEIN OTHER
|
Facility
|
OP
|
$65.44
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3008415701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$62.17 |
| Rate for Payer: Aetna of VT Commercial |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$53.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$52.02
|
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Cigna Commercial |
$52.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$52.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$52.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$29.45
|
| Rate for Payer: Multiplan Commercial |
$60.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$55.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$29.45
|
| Rate for Payer: United Healthcare Commercial |
$62.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare VA CCN |
$29.45
|
|
|
ASSAY OF PROTEIN SERUM
|
Professional
|
Both
|
$43.43
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
3008415501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna of VT Commercial |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.27
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$4.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$5.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare VA CCN |
$3.67
|
|
|
ASSAY OF PROTEIN SERUM
|
Facility
|
OP
|
$43.43
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
3008415501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Aetna of VT Commercial |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.53
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$19.54
|
| Rate for Payer: United Healthcare Commercial |
$41.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare VA CCN |
$19.54
|
|
|
ASSAY OF PROTEIN SERUM
|
Facility
|
IP
|
$43.43
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
3008415501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.14 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Aetna of VT Commercial |
$41.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$32.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.74
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cigna Commercial |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$34.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$34.74
|
| Rate for Payer: Multiplan Commercial |
$40.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.92
|
| Rate for Payer: United Healthcare Commercial |
$41.26
|
|
|
ASSAY OF PROTEIN URINE
|
Facility
|
IP
|
$62.98
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3008415601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: Aetna of VT Commercial |
$59.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$46.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$46.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.38
|
| Rate for Payer: Cash Price |
$31.49
|
| Rate for Payer: Cigna Commercial |
$50.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.38
|
| Rate for Payer: Multiplan Commercial |
$58.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.53
|
| Rate for Payer: United Healthcare Commercial |
$59.83
|
|
|
ASSAY OF PROTEIN URINE
|
Professional
|
Both
|
$62.98
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3008415601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: Aetna of VT Commercial |
$59.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.27
|
| Rate for Payer: Cash Price |
$31.49
|
| Rate for Payer: Cash Price |
$31.49
|
| Rate for Payer: Cigna Commercial |
$4.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.67
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.67
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$58.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$5.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare VA CCN |
$3.67
|
|
|
ASSAY OF PROTEIN URINE
|
Facility
|
OP
|
$62.98
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3008415601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: Aetna of VT Commercial |
$59.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.07
|
| Rate for Payer: Cash Price |
$31.49
|
| Rate for Payer: Cash Price |
$31.49
|
| Rate for Payer: Cigna Commercial |
$50.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$28.34
|
| Rate for Payer: Multiplan Commercial |
$58.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.34
|
| Rate for Payer: United Healthcare Commercial |
$59.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare VA CCN |
$28.34
|
|
|
ASSAY OF PSA FREE
|
Facility
|
OP
|
$207.83
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3008415401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$125.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$165.22
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$93.52
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$93.52
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare VA CCN |
$93.52
|
|
|
ASSAY OF PSA FREE
|
Facility
|
IP
|
$207.83
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3008415401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$197.44 |
| Rate for Payer: Aetna of VT Commercial |
$197.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$153.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$176.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$166.26
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$166.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$166.26
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.66
|
| Rate for Payer: United Healthcare Commercial |
$197.44
|
|
|
ASSAY OF PSA FREE
|
Professional
|
Both
|
$207.83
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3008415401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$195.36 |
| Rate for Payer: Aetna of VT Commercial |
$195.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.43
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cigna Commercial |
$22.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$193.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$28.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare VA CCN |
$18.39
|
|
|
ASSAY OF PSA TOTAL DIAGNOSTIC
|
Facility
|
IP
|
$159.24
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3008415301
|
|
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 PSA TOTAL DIAGNOSTIC
|
Facility
|
OP
|
$159.24
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3008415301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| 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 |
$90.62
|
| 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 |
$90.62
|
| 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 |
$18.39
|
| Rate for Payer: United Healthcare VA CCN |
$71.66
|
|
|
ASSAY OF PSA TOTAL DIAGNOSTIC
|
Professional
|
Both
|
$159.24
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3008415301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.13 |
| 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 |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$31.43
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cigna Commercial |
$22.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$148.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$28.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare VA CCN |
$18.39
|
|
|
ASSAY OF RENIN
|
Professional
|
Both
|
$246.35
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
3008424401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$231.57 |
| Rate for Payer: Aetna of VT Commercial |
$231.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$37.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.59
|
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Cigna Commercial |
$26.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$229.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare Commercial |
$33.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare VA CCN |
$21.99
|
|
|
ASSAY OF RENIN
|
Facility
|
OP
|
$246.35
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
3008424401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna of VT Commercial |
$234.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.85
|
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Cigna Commercial |
$197.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.86
|
| Rate for Payer: Multiplan Commercial |
$229.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.86
|
| Rate for Payer: United Healthcare Commercial |
$234.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare VA CCN |
$110.86
|
|
|
ASSAY OF RENIN
|
Facility
|
IP
|
$246.35
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
3008424401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna of VT Commercial |
$234.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.08
|
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Cigna Commercial |
$197.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.08
|
| Rate for Payer: Multiplan Commercial |
$229.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.40
|
| Rate for Payer: United Healthcare Commercial |
$234.03
|
|
|
ASSAY OF SELENIUM
|
Facility
|
IP
|
$300.27
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
3008425501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$222.23 |
| Max. Negotiated Rate |
$285.26 |
| Rate for Payer: Aetna of VT Commercial |
$285.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$252.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$240.22
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cigna Commercial |
$240.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.22
|
| Rate for Payer: Multiplan Commercial |
$279.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.23
|
| Rate for Payer: United Healthcare Commercial |
$285.26
|
|
|
ASSAY OF SELENIUM
|
Facility
|
OP
|
$300.27
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
3008425501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$285.26 |
| Rate for Payer: Aetna of VT Commercial |
$285.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$180.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$255.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$243.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$135.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$238.71
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cigna Commercial |
$240.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$240.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$240.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$135.12
|
| Rate for Payer: Multiplan Commercial |
$279.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$255.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$135.12
|
| Rate for Payer: United Healthcare Commercial |
$285.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.53
|
| Rate for Payer: United Healthcare VA CCN |
$135.12
|
|
|
ASSAY OF SELENIUM
|
Professional
|
Both
|
$300.27
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
3008425501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$282.25 |
| Rate for Payer: Aetna of VT Commercial |
$282.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$43.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.63
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cigna Commercial |
$30.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.17
|
| Rate for Payer: Multiplan Commercial |
$279.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.53
|
| Rate for Payer: United Healthcare Commercial |
$39.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.53
|
| Rate for Payer: United Healthcare VA CCN |
$25.53
|
|
