|
SL TETANUS-DIPHTHERIA TOXOIDS
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90714 SL
|
| Hospital Charge Code |
6369071402
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$45.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.37
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL TETANUS-DIPHTHERIA TOXOIDS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90714 SL
|
| Hospital Charge Code |
6369071402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
SL TETANUS-DIPHTHERIA TOXOIDS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90714 SL
|
| Hospital Charge Code |
6369071402
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL TETANUS/DIPTHERIA/PERTUSIS
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90715 SL
|
| Hospital Charge Code |
6369071502
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$50.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.07
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.81
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL TETANUS/DIPTHERIA/PERTUSIS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90715 SL
|
| Hospital Charge Code |
6369071502
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SL TETANUS/DIPTHERIA/PERTUSIS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90715 SL
|
| Hospital Charge Code |
6369071502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
SL VARICELLA-ZOSTER GE/AS01B
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90750 SL
|
| Hospital Charge Code |
6369075002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$592.65 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$592.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$235.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$280.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$280.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$228.44
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$196.00
|
|
|
SL VAR VACCINE LIVE SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90716 SL
|
| Hospital Charge Code |
6369071601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
SL VAR VACCINE LIVE SUBQ
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
6369071601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$503.25 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$158.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$259.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$259.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.98
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare VA CCN |
$176.00
|
|
|
SL VAR VACCINE LIVE SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90716 SL
|
| Hospital Charge Code |
6369071601
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$503.25 |
| Rate for Payer: Aetna of VT Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$503.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$503.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.00
|
| Rate for Payer: United Healthcare VA CCN |
$0.00
|
|
|
SMEAR COMPLEX STAIN
|
Professional
|
Both
|
$152.52
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
3008720901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$143.37 |
| Rate for Payer: Aetna of VT Commercial |
$143.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$26.16
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$21.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.73
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare Commercial |
$27.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare VA CCN |
$17.98
|
|
|
SMEAR COMPLEX STAIN
|
Facility
|
OP
|
$152.52
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
3008720901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$144.89 |
| Rate for Payer: Aetna of VT Commercial |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$123.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$121.25
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$68.63
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$68.63
|
| Rate for Payer: United Healthcare Commercial |
$144.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare VA CCN |
$68.63
|
|
|
SMEAR COMPLEX STAIN
|
Facility
|
IP
|
$152.52
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
3008720901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$144.89 |
| Rate for Payer: Aetna of VT Commercial |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$122.02
|
| Rate for Payer: Cash Price |
$76.26
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$122.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$122.02
|
| Rate for Payer: Multiplan Commercial |
$141.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$129.64
|
| Rate for Payer: United Healthcare Commercial |
$144.89
|
|
|
SMEAR FLUORESCENT/ACID STAI
|
Facility
|
OP
|
$103.56
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3008720601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$98.38 |
| Rate for Payer: Aetna of VT Commercial |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$45.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$62.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$83.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$46.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.33
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cigna Commercial |
$82.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.60
|
| Rate for Payer: Multiplan Commercial |
$96.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.60
|
| Rate for Payer: United Healthcare Commercial |
$98.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare VA CCN |
$46.60
|
|
|
SMEAR FLUORESCENT/ACID STAI
|
Facility
|
IP
|
$103.56
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3008720601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.64 |
| Max. Negotiated Rate |
$98.38 |
| Rate for Payer: Aetna of VT Commercial |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$76.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$76.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$88.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$86.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$82.85
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cigna Commercial |
$82.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$82.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$82.85
|
| Rate for Payer: Multiplan Commercial |
$96.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.03
|
| Rate for Payer: United Healthcare Commercial |
$98.38
|
|
|
SMEAR FLUORESCENT/ACID STAI
|
Professional
|
Both
|
$103.56
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
3008720601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$97.35 |
| Rate for Payer: Aetna of VT Commercial |
$97.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7.85
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cigna Commercial |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$96.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$8.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare VA CCN |
$5.39
|
|
|
SMEAR GRAM STAIN
|
Facility
|
OP
|
$88.89
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
300872050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.45 |
| Rate for Payer: Aetna of VT Commercial |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.67
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cigna Commercial |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$82.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$84.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$40.00
|
|
|
SMEAR GRAM STAIN
|
Facility
|
IP
|
$88.89
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3008720501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$84.45 |
| Rate for Payer: Aetna of VT Commercial |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.11
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cigna Commercial |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.11
|
| Rate for Payer: Multiplan Commercial |
$82.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.56
|
| Rate for Payer: United Healthcare Commercial |
$84.45
|
|
|
SMEAR GRAM STAIN
|
Facility
|
IP
|
$88.89
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
300872050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$84.45 |
| Rate for Payer: Aetna of VT Commercial |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$74.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$71.11
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cigna Commercial |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.11
|
| Rate for Payer: Multiplan Commercial |
$82.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.56
|
| Rate for Payer: United Healthcare Commercial |
$84.45
|
|
|
SMEAR GRAM STAIN
|
Facility
|
OP
|
$88.89
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3008720501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.45 |
| Rate for Payer: Aetna of VT Commercial |
$84.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$39.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$53.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$75.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.67
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cigna Commercial |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$71.11
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$71.11
|
| Rate for Payer: Martins Point Health Care Commercial |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$82.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$84.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$40.00
|
|
|
SMEAR GRAM STAIN
|
Professional
|
Both
|
$88.89
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3008720501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$83.56 |
| Rate for Payer: Aetna of VT Commercial |
$83.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.22
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cash Price |
$44.44
|
| Rate for Payer: Cigna Commercial |
$5.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.27
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.27
|
| Rate for Payer: Martins Point Health Care Commercial |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$82.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$6.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare VA CCN |
$4.27
|
|
|
SMEAR SPECIAL STAIN
|
Facility
|
OP
|
$122.82
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3008720701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna of VT Commercial |
$116.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$73.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.64
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cigna Commercial |
$98.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.27
|
| Rate for Payer: Multiplan Commercial |
$114.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.27
|
| Rate for Payer: United Healthcare Commercial |
$116.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare VA CCN |
$55.27
|
|
|
SMEAR SPECIAL STAIN
|
Professional
|
Both
|
$122.82
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3008720701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Aetna of VT Commercial |
$115.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.98
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cigna Commercial |
$27.68
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.91
|
| Rate for Payer: Multiplan Commercial |
$114.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$9.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare VA CCN |
$5.99
|
|
|
SMEAR SPECIAL STAIN
|
Facility
|
IP
|
$122.82
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3008720701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$116.68 |
| Rate for Payer: Aetna of VT Commercial |
$116.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$103.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.26
|
| Rate for Payer: Cash Price |
$61.41
|
| Rate for Payer: Cigna Commercial |
$98.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$98.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$98.26
|
| Rate for Payer: Multiplan Commercial |
$114.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$104.40
|
| Rate for Payer: United Healthcare Commercial |
$116.68
|
|
|
SMEAR WET MOUNT SALINE/INK
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
300872100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of VT Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
