|
ASSAY OF URINE OSMOLALITY
|
Facility
|
OP
|
$121.61
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
3008393501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$115.53 |
| Rate for Payer: Aetna of VT Commercial |
$115.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$53.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$98.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$96.68
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna Commercial |
$97.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.72
|
| Rate for Payer: United Healthcare Commercial |
$115.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.82
|
| Rate for Payer: United Healthcare VA CCN |
$54.72
|
|
|
ASSAY OF URINE OSMOLALITY
|
Professional
|
Both
|
$121.61
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
3008393501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$114.31 |
| Rate for Payer: Aetna of VT Commercial |
$114.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.66
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna Commercial |
$8.33
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.82
|
| Rate for Payer: United Healthcare Commercial |
$10.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.82
|
| Rate for Payer: United Healthcare VA CCN |
$6.82
|
|
|
ASSAY OF URINE OSMOLALITY
|
Facility
|
IP
|
$121.61
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
3008393501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$115.53 |
| Rate for Payer: Aetna of VT Commercial |
$115.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$103.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$102.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.29
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cigna Commercial |
$97.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$97.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$97.29
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$103.37
|
| Rate for Payer: United Healthcare Commercial |
$115.53
|
|
|
ASSAY OF URINE PHOSPHORUS
|
Professional
|
Both
|
$75.31
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3008410501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$70.79 |
| Rate for Payer: Aetna of VT Commercial |
$70.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.88
|
| Rate for Payer: Cash Price |
$37.66
|
| Rate for Payer: Cash Price |
$37.66
|
| Rate for Payer: Cigna Commercial |
$7.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.70
|
| Rate for Payer: Multiplan Commercial |
$70.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$8.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare VA CCN |
$5.78
|
|
|
ASSAY OF URINE PHOSPHORUS
|
Facility
|
OP
|
$75.31
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3008410501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna of VT Commercial |
$71.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$33.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.87
|
| Rate for Payer: Cash Price |
$37.66
|
| Rate for Payer: Cash Price |
$37.66
|
| Rate for Payer: Cigna Commercial |
$60.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.89
|
| Rate for Payer: Multiplan Commercial |
$70.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$33.89
|
| Rate for Payer: United Healthcare Commercial |
$71.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare VA CCN |
$33.89
|
|
|
ASSAY OF URINE PHOSPHORUS
|
Facility
|
IP
|
$75.31
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3008410501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna of VT Commercial |
$71.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.25
|
| Rate for Payer: Cash Price |
$37.66
|
| Rate for Payer: Cigna Commercial |
$60.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$60.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$60.25
|
| Rate for Payer: Multiplan Commercial |
$70.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.01
|
| Rate for Payer: United Healthcare Commercial |
$71.54
|
|
|
ASSAY OF URINE PORPHYRINS
|
Professional
|
Both
|
$142.52
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3008412001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$133.97 |
| Rate for Payer: Aetna of VT Commercial |
$133.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.14
|
| Rate for Payer: Cash Price |
$71.26
|
| Rate for Payer: Cash Price |
$71.26
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$132.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare Commercial |
$22.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare VA CCN |
$14.71
|
|
|
ASSAY OF URINE PORPHYRINS
|
Facility
|
OP
|
$142.52
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3008412001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$135.39 |
| Rate for Payer: Aetna of VT Commercial |
$135.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$113.30
|
| Rate for Payer: Cash Price |
$71.26
|
| Rate for Payer: Cash Price |
$71.26
|
| Rate for Payer: Cigna Commercial |
$114.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$64.13
|
| Rate for Payer: Multiplan Commercial |
$132.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.14
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$64.13
|
| Rate for Payer: United Healthcare Commercial |
$135.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare VA CCN |
$64.13
|
|
|
ASSAY OF URINE PORPHYRINS
|
Facility
|
IP
|
$142.52
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3008412001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.48 |
| Max. Negotiated Rate |
$135.39 |
| Rate for Payer: Aetna of VT Commercial |
$135.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$105.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$105.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$121.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.02
|
| Rate for Payer: Cash Price |
$71.26
|
| Rate for Payer: Cigna Commercial |
$114.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$114.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$114.02
|
| Rate for Payer: Multiplan Commercial |
$132.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.14
|
| Rate for Payer: United Healthcare Commercial |
$135.39
|
|
|
ASSAY OF URINE SODIUM
|
Facility
|
OP
|
$79.62
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3008430001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Aetna of VT Commercial |
$75.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$47.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.30
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cigna Commercial |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.68
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.83
|
| Rate for Payer: United Healthcare Commercial |
$75.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Healthcare VA CCN |
$35.83
|
|
|
ASSAY OF URINE SODIUM
|
Facility
|
IP
|
$79.62
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3008430001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Aetna of VT Commercial |
$75.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$58.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$58.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.70
|
| Rate for Payer: Cash Price |
$39.81
|
| Rate for Payer: Cigna Commercial |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.68
|
| Rate for Payer: United Healthcare Commercial |
$75.64
|
|
|
ASSAY OF URINE/UREA-N
|
Facility
|
IP
|
$84.82
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
3008454001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$80.58 |
| Rate for Payer: Aetna of VT Commercial |
$80.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.86
|
| Rate for Payer: Cash Price |
$42.41
|
| Rate for Payer: Cigna Commercial |
$67.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$78.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$80.58
|
|
|
ASSAY OF URINE/UREA-N
|
Facility
|
OP
|
$84.82
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
3008454001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$80.58 |
| Rate for Payer: Aetna of VT Commercial |
$80.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$37.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$67.43
|
| Rate for Payer: Cash Price |
$42.41
|
| Rate for Payer: Cash Price |
$42.41
|
| Rate for Payer: Cigna Commercial |
$67.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$67.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$67.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.17
|
| Rate for Payer: Multiplan Commercial |
$78.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.17
|
| Rate for Payer: United Healthcare Commercial |
$80.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare VA CCN |
$38.17
|
|
|
ASSAY OF URINE/UREA-N
|
Professional
|
Both
|
$84.82
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
3008454001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$79.73 |
| Rate for Payer: Aetna of VT Commercial |
$79.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.50
|
| Rate for Payer: Cash Price |
$42.41
|
| Rate for Payer: Cash Price |
$42.41
|
| Rate for Payer: Cigna Commercial |
$6.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.56
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.56
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$78.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare Commercial |
$8.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare VA CCN |
$5.56
|
|
|
ASSAY OF URINE/URIC ACID
|
Professional
|
Both
|
$79.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3008456001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna of VT Commercial |
$75.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.68
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.01
|
| Rate for Payer: Multiplan Commercial |
$74.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: United Healthcare VA CCN |
$5.08
|
|
|
ASSAY OF URINE/URIC ACID
|
Facility
|
OP
|
$79.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3008456001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$75.89 |
| Rate for Payer: Aetna of VT Commercial |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$35.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.50
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cigna Commercial |
$63.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.95
|
| Rate for Payer: Multiplan Commercial |
$74.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.95
|
| Rate for Payer: United Healthcare Commercial |
$75.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: United Healthcare VA CCN |
$35.95
|
|
|
ASSAY OF URINE/URIC ACID
|
Facility
|
IP
|
$79.88
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3008456001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$75.89 |
| Rate for Payer: Aetna of VT Commercial |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$59.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$59.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$67.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$63.90
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cigna Commercial |
$63.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$63.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$74.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.90
|
| Rate for Payer: United Healthcare Commercial |
$75.89
|
|
|
ASSAY OF VANCOMYCIN
|
Facility
|
IP
|
$223.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3008020201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.65 |
| Max. Negotiated Rate |
$212.63 |
| Rate for Payer: Aetna of VT Commercial |
$212.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$165.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$165.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$188.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.06
|
| Rate for Payer: Cash Price |
$111.91
|
| Rate for Payer: Cigna Commercial |
$179.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.06
|
| Rate for Payer: Multiplan Commercial |
$208.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.25
|
| Rate for Payer: United Healthcare Commercial |
$212.63
|
|
|
ASSAY OF VANCOMYCIN
|
Facility
|
OP
|
$223.82
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
3008020201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$212.63 |
| Rate for Payer: Aetna of VT Commercial |
$212.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$134.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$190.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$100.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$177.94
|
| Rate for Payer: Cash Price |
$111.91
|
| Rate for Payer: Cash Price |
$111.91
|
| Rate for Payer: Cigna Commercial |
$179.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$179.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$179.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$100.72
|
| Rate for Payer: Multiplan Commercial |
$208.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$190.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$100.72
|
| Rate for Payer: United Healthcare Commercial |
$212.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare VA CCN |
$100.72
|
|
|
ASSAY OF VITAMIN A
|
Facility
|
IP
|
$204.73
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
3008459001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.52 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$151.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$163.78
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
|
|
ASSAY OF VITAMIN A
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
3008459001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$194.49 |
| Rate for Payer: Aetna of VT Commercial |
$194.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$123.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.76
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$92.13
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$92.13
|
| Rate for Payer: United Healthcare Commercial |
$194.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare VA CCN |
$92.13
|
|
|
ASSAY OF VITAMIN A
|
Professional
|
Both
|
$204.73
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
3008459001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$192.45 |
| Rate for Payer: Aetna of VT Commercial |
$192.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$57.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$57.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$16.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.83
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.45
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$17.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare VA CCN |
$11.61
|
|
|
ASSAY OF VITAMIN B-2
|
Facility
|
OP
|
$82.20
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
3008425201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$99.73 |
| Rate for Payer: Aetna of VT Commercial |
$78.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.35
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.99
|
| Rate for Payer: Multiplan Commercial |
$76.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.99
|
| Rate for Payer: United Healthcare Commercial |
$78.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.24
|
| Rate for Payer: United Healthcare VA CCN |
$36.99
|
|
|
ASSAY OF VITAMIN B-2
|
Professional
|
Both
|
$82.20
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
3008425201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$99.73 |
| Rate for Payer: Aetna of VT Commercial |
$77.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$99.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$99.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$28.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$34.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$23.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$34.60
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$24.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$20.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$20.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$19.96
|
| Rate for Payer: Multiplan Commercial |
$76.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$20.24
|
| Rate for Payer: United Healthcare Commercial |
$31.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.24
|
| Rate for Payer: United Healthcare VA CCN |
$20.24
|
|
|
ASSAY OF VITAMIN B-2
|
Facility
|
IP
|
$82.20
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
3008425201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$78.09 |
| Rate for Payer: Aetna of VT Commercial |
$78.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.76
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$76.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.87
|
| Rate for Payer: United Healthcare Commercial |
$78.09
|
|
