|
ASSAY OF THYROID (T3 OR T4)
|
Professional
|
Both
|
$194.65
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
3008447901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna of VT Commercial |
$182.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.05
|
| Rate for Payer: Cash Price |
$97.33
|
| Rate for Payer: Cash Price |
$97.33
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$181.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$9.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare VA CCN |
$6.47
|
|
|
ASSAY OF THYROID (T3 OR T4)
|
Facility
|
IP
|
$194.65
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
3008447901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.06 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna of VT Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.72
|
| Rate for Payer: Cash Price |
$97.33
|
| Rate for Payer: Cigna Commercial |
$155.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.72
|
| Rate for Payer: Multiplan Commercial |
$181.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.45
|
| Rate for Payer: United Healthcare Commercial |
$184.92
|
|
|
ASSAY OF THYROID (T3 OR T4)
|
Facility
|
OP
|
$194.65
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
3008447901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna of VT Commercial |
$184.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$154.75
|
| Rate for Payer: Cash Price |
$97.33
|
| Rate for Payer: Cash Price |
$97.33
|
| Rate for Payer: Cigna Commercial |
$155.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.59
|
| Rate for Payer: Multiplan Commercial |
$181.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.59
|
| Rate for Payer: United Healthcare Commercial |
$184.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare VA CCN |
$87.59
|
|
|
ASSAY OF THYROXINE TOTAL
|
Facility
|
OP
|
$88.10
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
3008443601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$83.69 |
| Rate for Payer: Aetna of VT Commercial |
$83.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.04
|
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Cigna Commercial |
$70.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.65
|
| Rate for Payer: Multiplan Commercial |
$81.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.65
|
| Rate for Payer: United Healthcare Commercial |
$83.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: United Healthcare VA CCN |
$39.65
|
|
|
ASSAY OF THYROXINE TOTAL
|
Facility
|
IP
|
$88.10
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
3008443601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$83.69 |
| Rate for Payer: Aetna of VT Commercial |
$83.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.48
|
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Cigna Commercial |
$70.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.48
|
| Rate for Payer: Multiplan Commercial |
$81.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.89
|
| Rate for Payer: United Healthcare Commercial |
$83.69
|
|
|
ASSAY OF THYROXINE TOTAL
|
Professional
|
Both
|
$88.10
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
3008443601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$82.81 |
| Rate for Payer: Aetna of VT Commercial |
$82.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.74
|
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Cash Price |
$44.05
|
| Rate for Payer: Cigna Commercial |
$8.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.77
|
| Rate for Payer: Multiplan Commercial |
$81.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$10.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: United Healthcare VA CCN |
$6.87
|
|
|
ASSAY OF TOPIRAMATE
|
Facility
|
OP
|
$210.94
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
3008020101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.70
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.92
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.92
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.92
|
| Rate for Payer: United Healthcare VA CCN |
$94.92
|
|
|
ASSAY OF TOPIRAMATE
|
Professional
|
Both
|
$210.94
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
3008020101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$198.28 |
| Rate for Payer: Aetna of VT Commercial |
$198.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$20.38
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$14.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.92
|
| Rate for Payer: United Healthcare VA CCN |
$11.92
|
|
|
ASSAY OF TOPIRAMATE
|
Facility
|
IP
|
$210.94
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
3008020101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$200.39 |
| Rate for Payer: Aetna of VT Commercial |
$200.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.75
|
| Rate for Payer: Cash Price |
$105.47
|
| Rate for Payer: Cigna Commercial |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$196.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.30
|
| Rate for Payer: United Healthcare Commercial |
$200.39
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Facility
|
IP
|
$174.75
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
3008267001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$166.01 |
| Rate for Payer: Aetna of VT Commercial |
$166.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$146.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.80
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$139.80
|
| Rate for Payer: Multiplan Commercial |
$162.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.54
|
| Rate for Payer: United Healthcare Commercial |
$166.01
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Facility
|
OP
|
$174.75
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
3008267001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$166.01 |
| Rate for Payer: Aetna of VT Commercial |
$166.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.93
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$139.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.64
|
| Rate for Payer: Multiplan Commercial |
$162.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.64
|
| Rate for Payer: United Healthcare Commercial |
$166.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare VA CCN |
$78.64
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Professional
|
Both
|
$174.75
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
3008267001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$164.26 |
| Rate for Payer: Aetna of VT Commercial |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$137.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$137.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$47.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$47.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.76
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cigna Commercial |
$33.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.55
|
| Rate for Payer: Multiplan Commercial |
$162.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare VA CCN |
$27.94
|
|
|
ASSAY OF TOTAL TESTOSTERONE
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
3008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$97.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.90
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare VA CCN |
$99.00
|
|
|
ASSAY OF TOTAL TESTOSTERONE
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
3008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna of VT Commercial |
$206.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$127.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.10
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$31.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare Commercial |
$39.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare VA CCN |
$25.81
|
|
|
ASSAY OF TOTAL TESTOSTERONE
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
3008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of VT Commercial |
$209.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$187.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$176.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$176.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$204.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$209.00
|
|
|
ASSAY OF TRIGLYCERIDES
|
Facility
|
IP
|
$80.65
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3008447801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of VT Commercial |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.52
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna Commercial |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.52
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.55
|
| Rate for Payer: United Healthcare Commercial |
$76.62
|
|
|
ASSAY OF TRIGLYCERIDES
|
Facility
|
OP
|
$80.65
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3008447801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of VT Commercial |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$68.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.12
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna Commercial |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$64.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$64.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.29
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$68.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.29
|
| Rate for Payer: United Healthcare Commercial |
$76.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare VA CCN |
$36.29
|
|
|
ASSAY OF TRIGLYCERIDES
|
Professional
|
Both
|
$80.65
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3008447801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$75.81 |
| Rate for Payer: Aetna of VT Commercial |
$75.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.80
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cash Price |
$40.33
|
| Rate for Payer: Cigna Commercial |
$7.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare Commercial |
$8.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare VA CCN |
$5.74
|
|
|
ASSAY OF TROPONIN QUANTITATIVE
|
Facility
|
IP
|
$174.75
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
3008448401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.33 |
| Max. Negotiated Rate |
$166.01 |
| Rate for Payer: Aetna of VT Commercial |
$166.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$129.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$146.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.80
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$139.80
|
| Rate for Payer: Multiplan Commercial |
$162.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.54
|
| Rate for Payer: United Healthcare Commercial |
$166.01
|
|
|
ASSAY OF TROPONIN QUANTITATIVE
|
Facility
|
OP
|
$174.75
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
3008448401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$166.01 |
| Rate for Payer: Aetna of VT Commercial |
$166.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$78.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.93
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cash Price |
$87.38
|
| Rate for Payer: Cigna Commercial |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$139.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$139.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$78.64
|
| Rate for Payer: Multiplan Commercial |
$162.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$78.64
|
| Rate for Payer: United Healthcare Commercial |
$166.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.47
|
| Rate for Payer: United Healthcare VA CCN |
$78.64
|
|
|
ASSAY OF TSI GLOBULIN
|
Facility
|
OP
|
$538.59
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
3008444501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$511.66 |
| Rate for Payer: Aetna of VT Commercial |
$511.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$238.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$324.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$436.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$242.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$428.18
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Cigna Commercial |
$430.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$242.37
|
| Rate for Payer: Multiplan Commercial |
$500.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$242.37
|
| Rate for Payer: United Healthcare Commercial |
$511.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: United Healthcare VA CCN |
$242.37
|
|
|
ASSAY OF TSI GLOBULIN
|
Facility
|
IP
|
$538.59
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
3008444501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.61 |
| Max. Negotiated Rate |
$511.66 |
| Rate for Payer: Aetna of VT Commercial |
$511.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$452.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.87
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Cigna Commercial |
$430.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.87
|
| Rate for Payer: Multiplan Commercial |
$500.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.80
|
| Rate for Payer: United Healthcare Commercial |
$511.66
|
|
|
ASSAY OF TSI GLOBULIN
|
Professional
|
Both
|
$538.59
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
3008444501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$506.27 |
| Rate for Payer: Aetna of VT Commercial |
$506.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$250.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$250.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$58.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$86.92
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Cash Price |
$269.30
|
| Rate for Payer: Cigna Commercial |
$61.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$50.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$50.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$50.15
|
| Rate for Payer: Multiplan Commercial |
$500.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$50.86
|
| Rate for Payer: United Healthcare Commercial |
$78.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: United Healthcare VA CCN |
$50.86
|
|
|
ASSAY OF UREA NITROGEN
|
Facility
|
OP
|
$41.88
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3008452001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$39.79 |
| Rate for Payer: Aetna of VT Commercial |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.29
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cigna Commercial |
$33.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.85
|
| Rate for Payer: Multiplan Commercial |
$38.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.85
|
| Rate for Payer: United Healthcare Commercial |
$39.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare VA CCN |
$18.85
|
|
|
ASSAY OF UREA NITROGEN
|
Facility
|
IP
|
$41.88
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3008452001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$39.79 |
| Rate for Payer: Aetna of VT Commercial |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.50
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cigna Commercial |
$33.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$38.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.60
|
| Rate for Payer: United Healthcare Commercial |
$39.79
|
|
