|
ASSAY OF SERUM ALBUMIN
|
Facility
|
IP
|
$73.63
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
3008204001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$69.95 |
| Rate for Payer: Aetna of VT Commercial |
$69.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$54.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.90
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.90
|
| Rate for Payer: Multiplan Commercial |
$68.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.59
|
| Rate for Payer: United Healthcare Commercial |
$69.95
|
|
|
ASSAY OF SERUM ALBUMIN
|
Facility
|
OP
|
$73.63
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
3008204001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$69.95 |
| Rate for Payer: Aetna of VT Commercial |
$69.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$32.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$44.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$58.54
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$58.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$58.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.13
|
| Rate for Payer: Multiplan Commercial |
$68.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$62.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.13
|
| Rate for Payer: United Healthcare Commercial |
$69.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$33.13
|
|
|
ASSAY OF SERUM ALBUMIN
|
Professional
|
Both
|
$73.63
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
3008204001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$69.21 |
| Rate for Payer: Aetna of VT Commercial |
$69.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.46
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.95
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.95
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$68.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$7.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare VA CCN |
$4.95
|
|
|
ASSAY OF SERUM POTASSIUM
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
3008413201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: Aetna of VT Commercial |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.08
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna Commercial |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$64.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.18
|
| Rate for Payer: United Healthcare Commercial |
$65.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: United Healthcare VA CCN |
$31.18
|
|
|
ASSAY OF SERUM POTASSIUM
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
3008413201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.27 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: Aetna of VT Commercial |
$65.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.42
|
| Rate for Payer: Cash Price |
$34.64
|
| Rate for Payer: Cigna Commercial |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.42
|
| Rate for Payer: Multiplan Commercial |
$64.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.89
|
| Rate for Payer: United Healthcare Commercial |
$65.82
|
|
|
ASSAY OF SERUM SODIUM
|
Facility
|
IP
|
$46.51
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
3008429501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$44.18 |
| Rate for Payer: Aetna of VT Commercial |
$44.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.21
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cigna Commercial |
$37.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.21
|
| Rate for Payer: Multiplan Commercial |
$43.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.53
|
| Rate for Payer: United Healthcare Commercial |
$44.18
|
|
|
ASSAY OF SERUM SODIUM
|
Facility
|
OP
|
$46.51
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
3008429501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$44.18 |
| Rate for Payer: Aetna of VT Commercial |
$44.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$39.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.98
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cigna Commercial |
$37.21
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.93
|
| Rate for Payer: Multiplan Commercial |
$43.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.93
|
| Rate for Payer: United Healthcare Commercial |
$44.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.81
|
| Rate for Payer: United Healthcare VA CCN |
$20.93
|
|
|
ASSAY OF SEX HORMONE GLOBUL
|
Professional
|
Both
|
$82.90
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3008427001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$77.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$37.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$37.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$37.15
|
| Rate for Payer: Cash Price |
$41.45
|
| Rate for Payer: Cash Price |
$41.45
|
| Rate for Payer: Cigna Commercial |
$26.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$21.43
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Commercial |
$33.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare VA CCN |
$21.73
|
|
|
ASSAY OF SEX HORMONE GLOBUL
|
Facility
|
OP
|
$82.90
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3008427001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of VT Commercial |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.91
|
| Rate for Payer: Cash Price |
$41.45
|
| Rate for Payer: Cash Price |
$41.45
|
| Rate for Payer: Cigna Commercial |
$66.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.30
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.30
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare VA CCN |
$37.30
|
|
|
ASSAY OF SEX HORMONE GLOBUL
|
Facility
|
IP
|
$82.90
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
3008427001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna of VT Commercial |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.32
|
| Rate for Payer: Cash Price |
$41.45
|
| Rate for Payer: Cigna Commercial |
$66.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.32
|
| Rate for Payer: Multiplan Commercial |
$77.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.47
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
|
|
ASSAY OF SOMATOMEDIN
|
Professional
|
Both
|
$255.40
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
3008430501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$240.08 |
| Rate for Payer: Aetna of VT Commercial |
$240.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.33
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$25.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.96
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare VA CCN |
$21.26
|
|
|
ASSAY OF SOMATOMEDIN
|
Facility
|
IP
|
$255.40
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
3008430501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.32
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
|
|
ASSAY OF SOMATOMEDIN
|
Facility
|
OP
|
$255.40
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
3008430501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.04
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.93
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.93
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare VA CCN |
$114.93
|
|
|
ASSAY OF TACROLIMUS
|
Professional
|
Both
|
$170.61
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
3008019701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$160.37 |
| Rate for Payer: Aetna of VT Commercial |
$160.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$17.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.24
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare Commercial |
$21.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare VA CCN |
$13.73
|
|
|
ASSAY OF TACROLIMUS
|
Facility
|
IP
|
$170.61
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
3008019701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$126.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$136.49
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
|
|
ASSAY OF TACROLIMUS
|
Facility
|
OP
|
$170.61
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
3008019701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$162.08 |
| Rate for Payer: Aetna of VT Commercial |
$162.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$145.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.63
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cash Price |
$85.31
|
| Rate for Payer: Cigna Commercial |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.77
|
| Rate for Payer: Multiplan Commercial |
$158.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$145.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Commercial |
$162.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare VA CCN |
$76.77
|
|
|
ASSAY OF THEOPHYLLINE
|
Facility
|
OP
|
$164.66
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
3008019801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$156.43 |
| Rate for Payer: Aetna of VT Commercial |
$156.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$99.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$130.90
|
| Rate for Payer: Cash Price |
$82.33
|
| Rate for Payer: Cash Price |
$82.33
|
| Rate for Payer: Cigna Commercial |
$131.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.10
|
| Rate for Payer: Multiplan Commercial |
$153.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$156.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare VA CCN |
$74.10
|
|
|
ASSAY OF THEOPHYLLINE
|
Facility
|
IP
|
$164.66
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
3008019801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.86 |
| Max. Negotiated Rate |
$156.43 |
| Rate for Payer: Aetna of VT Commercial |
$156.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$121.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$121.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$139.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$131.73
|
| Rate for Payer: Cash Price |
$82.33
|
| Rate for Payer: Cigna Commercial |
$131.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$131.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$131.73
|
| Rate for Payer: Multiplan Commercial |
$153.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$139.96
|
| Rate for Payer: United Healthcare Commercial |
$156.43
|
|
|
ASSAY OF THEOPHYLLINE
|
Professional
|
Both
|
$164.66
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
3008019801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$154.78 |
| Rate for Payer: Aetna of VT Commercial |
$154.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.17
|
| Rate for Payer: Cash Price |
$82.33
|
| Rate for Payer: Cash Price |
$82.33
|
| Rate for Payer: Cigna Commercial |
$17.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$153.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare VA CCN |
$14.14
|
|
|
ASSAY OF THIAMINE-VITAMIN B-1
|
Facility
|
IP
|
$331.28
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
3008442501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.18 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna of VT Commercial |
$314.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$245.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$245.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$278.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$265.02
|
| Rate for Payer: Cash Price |
$165.64
|
| Rate for Payer: Cigna Commercial |
$265.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.02
|
| Rate for Payer: Multiplan Commercial |
$308.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.59
|
| Rate for Payer: United Healthcare Commercial |
$314.72
|
|
|
ASSAY OF THIAMINE-VITAMIN B-1
|
Facility
|
OP
|
$331.28
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
3008442501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$314.72 |
| Rate for Payer: Aetna of VT Commercial |
$314.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$146.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$199.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$149.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.37
|
| Rate for Payer: Cash Price |
$165.64
|
| Rate for Payer: Cash Price |
$165.64
|
| Rate for Payer: Cigna Commercial |
$265.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$265.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$265.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$149.08
|
| Rate for Payer: Multiplan Commercial |
$308.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.08
|
| Rate for Payer: United Healthcare Commercial |
$314.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare VA CCN |
$149.08
|
|
|
ASSAY OF THIAMINE-VITAMIN B-1
|
Professional
|
Both
|
$331.28
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
3008442501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of VT Commercial |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$104.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$36.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$36.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$36.28
|
| Rate for Payer: Cash Price |
$165.64
|
| Rate for Payer: Cash Price |
$165.64
|
| Rate for Payer: Cigna Commercial |
$25.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$21.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$21.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$20.93
|
| Rate for Payer: Multiplan Commercial |
$308.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare Commercial |
$32.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare VA CCN |
$21.23
|
|
|
ASSAY OF THYROGLOBULIN
|
Facility
|
OP
|
$148.59
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3008443201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna of VT Commercial |
$141.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$65.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$89.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$126.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.13
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cigna Commercial |
$118.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.87
|
| Rate for Payer: Multiplan Commercial |
$138.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.87
|
| Rate for Payer: United Healthcare Commercial |
$141.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare VA CCN |
$66.87
|
|
|
ASSAY OF THYROGLOBULIN
|
Professional
|
Both
|
$148.59
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3008443201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$139.67 |
| Rate for Payer: Aetna of VT Commercial |
$139.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.45
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cigna Commercial |
$19.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$138.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare Commercial |
$24.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare VA CCN |
$16.06
|
|
|
ASSAY OF THYROGLOBULIN
|
Facility
|
IP
|
$148.59
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3008443201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.97 |
| Max. Negotiated Rate |
$141.16 |
| Rate for Payer: Aetna of VT Commercial |
$141.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$109.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$109.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$126.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$124.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$118.87
|
| Rate for Payer: Cash Price |
$74.30
|
| Rate for Payer: Cigna Commercial |
$118.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$118.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$118.87
|
| Rate for Payer: Multiplan Commercial |
$138.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.30
|
| Rate for Payer: United Healthcare Commercial |
$141.16
|
|
