|
ASSAY OF VITAMIN B-6
|
Facility
|
OP
|
$294.17
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
3008420701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$279.46 |
| Rate for Payer: Aetna of VT Commercial |
$279.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$177.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$238.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$233.87
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.34
|
| Rate for Payer: Martins Point Health Care Commercial |
$132.38
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$132.38
|
| Rate for Payer: United Healthcare Commercial |
$279.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: United Healthcare VA CCN |
$132.38
|
|
|
ASSAY OF VITAMIN B-6
|
Facility
|
IP
|
$294.17
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
3008420701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$279.46 |
| Rate for Payer: Aetna of VT Commercial |
$279.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$217.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$217.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$250.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.34
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$235.34
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$235.34
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$250.04
|
| Rate for Payer: United Healthcare Commercial |
$279.46
|
|
|
ASSAY OF VITAMIN B-6
|
Professional
|
Both
|
$294.17
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
3008420701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna of VT Commercial |
$276.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$28.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$39.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$32.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$48.03
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cash Price |
$147.08
|
| Rate for Payer: Cigna Commercial |
$34.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$273.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$28.10
|
| Rate for Payer: United Healthcare Commercial |
$43.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: United Healthcare VA CCN |
$28.10
|
|
|
ASSAY OF VITAMIN E
|
Facility
|
IP
|
$184.05
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
3008444601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna of VT Commercial |
$174.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$136.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$154.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$147.24
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$147.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.24
|
| Rate for Payer: Multiplan Commercial |
$171.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.44
|
| Rate for Payer: United Healthcare Commercial |
$174.85
|
|
|
ASSAY OF VITAMIN E
|
Professional
|
Both
|
$184.05
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
3008444601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$173.01 |
| Rate for Payer: Aetna of VT Commercial |
$173.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.23
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$17.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$14.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$14.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.98
|
| Rate for Payer: Multiplan Commercial |
$171.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare VA CCN |
$14.18
|
|
|
ASSAY OF VITAMIN E
|
Facility
|
OP
|
$184.05
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
3008444601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna of VT Commercial |
$174.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$81.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$110.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$156.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$149.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$82.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$146.32
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$147.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$147.24
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$147.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$82.82
|
| Rate for Payer: Multiplan Commercial |
$171.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$156.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$82.82
|
| Rate for Payer: United Healthcare Commercial |
$174.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare VA CCN |
$82.82
|
|
|
ASSAY OF VITAMIN K
|
Professional
|
Both
|
$62.04
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
3008459701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$67.61 |
| Rate for Payer: Aetna of VT Commercial |
$58.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$23.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$23.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$23.45
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cigna Commercial |
$16.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$57.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare Commercial |
$21.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare VA CCN |
$13.72
|
|
|
ASSAY OF VITAMIN K
|
Facility
|
OP
|
$62.04
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
3008459701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$67.61 |
| Rate for Payer: Aetna of VT Commercial |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$27.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.32
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cigna Commercial |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$27.92
|
| Rate for Payer: Multiplan Commercial |
$57.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$27.92
|
| Rate for Payer: United Healthcare Commercial |
$58.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare VA CCN |
$27.92
|
|
|
ASSAY OF VITAMIN K
|
Facility
|
IP
|
$62.04
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
3008459701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.92 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna of VT Commercial |
$58.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$52.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$52.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$49.63
|
| Rate for Payer: Cash Price |
$31.02
|
| Rate for Payer: Cigna Commercial |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$49.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$49.63
|
| Rate for Payer: Multiplan Commercial |
$57.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.73
|
| Rate for Payer: United Healthcare Commercial |
$58.94
|
|
|
ASSAY OF ZINC
|
Facility
|
OP
|
$144.58
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3008463001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$137.35 |
| Rate for Payer: Aetna of VT Commercial |
$137.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$114.94
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: Cigna Commercial |
$115.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.06
|
| Rate for Payer: Multiplan Commercial |
$134.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.06
|
| Rate for Payer: United Healthcare Commercial |
$137.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare VA CCN |
$65.06
|
|
|
ASSAY OF ZINC
|
Professional
|
Both
|
$144.58
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3008463001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$135.91 |
| Rate for Payer: Aetna of VT Commercial |
$135.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$11.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$15.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$19.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.48
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: Cigna Commercial |
$13.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$11.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$11.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$134.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare Commercial |
$17.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare VA CCN |
$11.39
|
|
|
ASSAY OF ZINC
|
Facility
|
IP
|
$144.58
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
3008463001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$137.35 |
| Rate for Payer: Aetna of VT Commercial |
$137.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$122.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.66
|
| Rate for Payer: Cash Price |
$72.29
|
| Rate for Payer: Cigna Commercial |
$115.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.66
|
| Rate for Payer: Multiplan Commercial |
$134.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$122.89
|
| Rate for Payer: United Healthcare Commercial |
$137.35
|
|
|
ASSAY PH BODY FLUID NOS
|
Professional
|
Both
|
$49.81
|
|
| Hospital Charge Code |
3008398601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna of VT Commercial |
$46.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.62
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: United Healthcare Commercial |
$42.34
|
| Rate for Payer: United Healthcare VA CCN |
$19.92
|
|
|
ASSAY PH BODY FLUID NOS
|
Facility
|
IP
|
$49.81
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3008398601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.86 |
| Max. Negotiated Rate |
$47.32 |
| Rate for Payer: Aetna of VT Commercial |
$47.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.85
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cigna Commercial |
$39.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.85
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.34
|
| Rate for Payer: United Healthcare Commercial |
$47.32
|
|
|
ASSAY PH BODY FLUID NOS
|
Facility
|
OP
|
$49.81
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3008398601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$47.32 |
| Rate for Payer: Aetna of VT Commercial |
$47.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.60
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cash Price |
$24.91
|
| Rate for Payer: Cigna Commercial |
$39.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.41
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.41
|
| Rate for Payer: United Healthcare Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare VA CCN |
$22.41
|
|
|
ASSAY RBC CHOLINESTERASE
|
Facility
|
OP
|
$179.71
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
3008248201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: Aetna of VT Commercial |
$170.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.87
|
| Rate for Payer: Cash Price |
$89.86
|
| Rate for Payer: Cash Price |
$89.86
|
| Rate for Payer: Cigna Commercial |
$143.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.77
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.87
|
| Rate for Payer: Multiplan Commercial |
$167.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.87
|
| Rate for Payer: United Healthcare Commercial |
$170.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.81
|
| Rate for Payer: United Healthcare VA CCN |
$80.87
|
|
|
ASSAY RBC CHOLINESTERASE
|
Professional
|
Both
|
$179.71
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
3008248201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$168.93 |
| Rate for Payer: Aetna of VT Commercial |
$168.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$11.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$16.76
|
| Rate for Payer: Cash Price |
$89.86
|
| Rate for Payer: Cash Price |
$89.86
|
| Rate for Payer: Cigna Commercial |
$11.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$9.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$9.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$167.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.81
|
| Rate for Payer: United Healthcare Commercial |
$15.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.81
|
| Rate for Payer: United Healthcare VA CCN |
$9.81
|
|
|
ASSAY RBC CHOLINESTERASE
|
Facility
|
IP
|
$179.71
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
3008248201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: Aetna of VT Commercial |
$170.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.77
|
| Rate for Payer: Cash Price |
$89.86
|
| Rate for Payer: Cigna Commercial |
$143.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.77
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.77
|
| Rate for Payer: Multiplan Commercial |
$167.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.75
|
| Rate for Payer: United Healthcare Commercial |
$170.72
|
|
|
ASSAY SERUM CHOLINESTERASE
|
Professional
|
Both
|
$81.69
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
3008248001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna of VT Commercial |
$76.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.45
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.87
|
| Rate for Payer: United Healthcare Commercial |
$12.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.87
|
| Rate for Payer: United Healthcare VA CCN |
$7.87
|
|
|
ASSAY SERUM CHOLINESTERASE
|
Facility
|
IP
|
$81.69
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
3008248001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.35
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
|
|
ASSAY SERUM CHOLINESTERASE
|
Facility
|
OP
|
$81.69
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
3008248001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.94
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.76
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.87
|
| Rate for Payer: United Healthcare VA CCN |
$36.76
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
OP
|
$246.61
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
3008207701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$234.28 |
| Rate for Payer: Aetna of VT Commercial |
$234.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$148.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$110.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$196.05
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Cigna Commercial |
$197.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$110.97
|
| Rate for Payer: Multiplan Commercial |
$229.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$110.97
|
| Rate for Payer: United Healthcare Commercial |
$234.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare VA CCN |
$110.97
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
IP
|
$246.61
|
|
|
Service Code
|
CPT 82077
|
| Hospital Charge Code |
3008207701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.52 |
| Max. Negotiated Rate |
$234.28 |
| Rate for Payer: Aetna of VT Commercial |
$234.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$182.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$182.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$209.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.29
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Cigna Commercial |
$197.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$197.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$197.29
|
| Rate for Payer: Multiplan Commercial |
$229.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$209.62
|
| Rate for Payer: United Healthcare Commercial |
$234.28
|
|
|
ASSAY TEST FOR BLOOD FECAL
|
Facility
|
OP
|
$49.63
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
3008227201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$47.15 |
| Rate for Payer: Aetna of VT Commercial |
$47.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$20.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$20.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.46
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna Commercial |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.33
|
| Rate for Payer: Multiplan Commercial |
$46.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.19
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.33
|
| Rate for Payer: United Healthcare Commercial |
$47.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: United Healthcare VA CCN |
$22.33
|
|
|
ASSAY TEST FOR BLOOD FECAL
|
Facility
|
OP
|
$85.82
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
3008227401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$81.53 |
| Rate for Payer: Aetna of VT Commercial |
$81.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$78.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$51.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$72.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.23
|
| Rate for Payer: Cash Price |
$42.91
|
| Rate for Payer: Cash Price |
$42.91
|
| Rate for Payer: Cigna Commercial |
$68.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$68.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$68.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.62
|
| Rate for Payer: Multiplan Commercial |
$79.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.62
|
| Rate for Payer: United Healthcare Commercial |
$81.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.92
|
| Rate for Payer: United Healthcare VA CCN |
$38.62
|
|
