|
BCR/ABL1 GENE MAJOR BP
|
Facility
|
IP
|
$665.90
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
3008120601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$492.83 |
| Max. Negotiated Rate |
$632.61 |
| Rate for Payer: Aetna of VT Commercial |
$632.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$492.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$492.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$559.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$532.72
|
| Rate for Payer: Cash Price |
$332.95
|
| Rate for Payer: Cigna Commercial |
$532.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.72
|
| Rate for Payer: Multiplan Commercial |
$619.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.01
|
| Rate for Payer: United Healthcare Commercial |
$632.61
|
|
|
BCR/ABL1 GENE MAJOR BP
|
Professional
|
Both
|
$665.90
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
3008120601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.66 |
| Max. Negotiated Rate |
$807.91 |
| Rate for Payer: Aetna of VT Commercial |
$625.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$807.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$168.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$807.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$229.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$280.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$280.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$280.24
|
| Rate for Payer: Cash Price |
$332.95
|
| Rate for Payer: Cash Price |
$332.95
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$163.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$163.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.66
|
| Rate for Payer: Multiplan Commercial |
$619.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$163.96
|
| Rate for Payer: United Healthcare Commercial |
$252.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.96
|
| Rate for Payer: United Healthcare VA CCN |
$163.96
|
|
|
BCR/ABL1 GENE MAJOR BP
|
Facility
|
OP
|
$665.90
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
3008120601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.96 |
| Max. Negotiated Rate |
$807.91 |
| Rate for Payer: Aetna of VT Commercial |
$632.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$807.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$294.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$807.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$400.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$539.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$299.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$529.39
|
| Rate for Payer: Cash Price |
$332.95
|
| Rate for Payer: Cash Price |
$332.95
|
| Rate for Payer: Cigna Commercial |
$532.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$532.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$532.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$299.65
|
| Rate for Payer: Multiplan Commercial |
$619.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$566.01
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$299.65
|
| Rate for Payer: United Healthcare Commercial |
$632.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.96
|
| Rate for Payer: United Healthcare VA CCN |
$299.65
|
|
|
BCR/ABL1 GENE MINOR BP
|
Facility
|
IP
|
$296.21
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
3008120701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$281.40 |
| Rate for Payer: Aetna of VT Commercial |
$281.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$219.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$219.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$248.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$236.97
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cigna Commercial |
$236.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.97
|
| Rate for Payer: Multiplan Commercial |
$275.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.78
|
| Rate for Payer: United Healthcare Commercial |
$281.40
|
|
|
BCR/ABL1 GENE MINOR BP
|
Facility
|
OP
|
$296.21
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
3008120701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.19 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna of VT Commercial |
$281.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$713.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$131.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$713.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$178.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$239.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$133.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$235.49
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cigna Commercial |
$236.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$236.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$236.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$133.29
|
| Rate for Payer: Multiplan Commercial |
$275.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$251.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$133.29
|
| Rate for Payer: United Healthcare Commercial |
$281.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.84
|
| Rate for Payer: United Healthcare VA CCN |
$133.29
|
|
|
BCR/ABL1 GENE MINOR BP
|
Professional
|
Both
|
$296.21
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
3008120701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna of VT Commercial |
$278.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$713.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$149.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$713.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$247.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$247.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$166.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.56
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cigna Commercial |
$175.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$142.81
|
| Rate for Payer: Multiplan Commercial |
$275.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.84
|
| Rate for Payer: United Healthcare Commercial |
$222.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.84
|
| Rate for Payer: United Healthcare VA CCN |
$144.84
|
|
|
BCR/ABL1 GENE OTHER BP
|
Professional
|
Both
|
$328.96
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
3008120801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.62 |
| Max. Negotiated Rate |
$1,057.54 |
| Rate for Payer: Aetna of VT Commercial |
$309.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,057.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$221.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,057.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$300.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$300.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$300.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$246.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.05
|
| Rate for Payer: Cash Price |
$164.48
|
| Rate for Payer: Cash Price |
$164.48
|
| Rate for Payer: Cigna Commercial |
$259.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$214.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$214.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.62
|
| Rate for Payer: Multiplan Commercial |
$305.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$214.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$214.62
|
| Rate for Payer: United Healthcare Commercial |
$330.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.62
|
| Rate for Payer: United Healthcare VA CCN |
$214.62
|
|
|
BCR/ABL1 GENE OTHER BP
|
Facility
|
OP
|
$328.96
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
3008120801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$1,057.54 |
| Rate for Payer: Aetna of VT Commercial |
$312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,057.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,057.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.52
|
| Rate for Payer: Cash Price |
$164.48
|
| Rate for Payer: Cash Price |
$164.48
|
| Rate for Payer: Cigna Commercial |
$263.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.03
|
| Rate for Payer: Multiplan Commercial |
$305.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.03
|
| Rate for Payer: United Healthcare Commercial |
$312.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.62
|
| Rate for Payer: United Healthcare VA CCN |
$148.03
|
|
|
BCR/ABL1 GENE OTHER BP
|
Facility
|
IP
|
$328.96
|
|
|
Service Code
|
CPT 81208
|
| Hospital Charge Code |
3008120801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.46 |
| Max. Negotiated Rate |
$312.51 |
| Rate for Payer: Aetna of VT Commercial |
$312.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.17
|
| Rate for Payer: Cash Price |
$164.48
|
| Rate for Payer: Cigna Commercial |
$263.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.17
|
| Rate for Payer: Multiplan Commercial |
$305.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.62
|
| Rate for Payer: United Healthcare Commercial |
$312.51
|
|
|
BEHAVRAL QUALIT ANALYS VOICE
|
Facility
|
IP
|
$376.38
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
4409252401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$278.56 |
| Max. Negotiated Rate |
$357.56 |
| Rate for Payer: Aetna of VT Commercial |
$357.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$316.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$301.10
|
| Rate for Payer: Cash Price |
$188.19
|
| Rate for Payer: Cigna Commercial |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.10
|
| Rate for Payer: Multiplan Commercial |
$350.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$319.92
|
| Rate for Payer: United Healthcare Commercial |
$357.56
|
|
|
BEHAVRAL QUALIT ANALYS VOICE
|
Facility
|
OP
|
$376.38
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
4409252401
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$357.56 |
| Rate for Payer: Aetna of VT Commercial |
$357.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$337.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$337.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$299.22
|
| Rate for Payer: Cash Price |
$188.19
|
| Rate for Payer: Cigna Commercial |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$301.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$301.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.37
|
| Rate for Payer: Multiplan Commercial |
$350.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.37
|
| Rate for Payer: United Healthcare Commercial |
$357.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.37
|
| Rate for Payer: United Healthcare VA CCN |
$169.37
|
|
|
BELT RIB FEMALE
|
Facility
|
IP
|
$3.38
|
|
| Hospital Charge Code |
2700022141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of VT Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.70
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$3.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.87
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
BELT RIB FEMALE
|
Facility
|
OP
|
$3.38
|
|
| Hospital Charge Code |
2700022141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna of VT Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.69
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.52
|
| Rate for Payer: Multiplan Commercial |
$3.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.52
|
| Rate for Payer: United Healthcare VA CCN |
$1.52
|
|
|
BELT RIB MALE
|
Facility
|
OP
|
$3.30
|
|
| Hospital Charge Code |
2700022131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of VT Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.62
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$3.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.49
|
| Rate for Payer: United Healthcare VA CCN |
$1.49
|
|
|
BELT RIB MALE
|
Facility
|
IP
|
$3.30
|
|
| Hospital Charge Code |
2700022131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna of VT Commercial |
$3.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2.64
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$3.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.81
|
| Rate for Payer: United Healthcare Commercial |
$3.13
|
|
|
BENZODIAZEPINES 13 OR MORE
|
Facility
|
IP
|
$31.94
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
3008034701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna of VT Commercial |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.55
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna Commercial |
$25.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.55
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.15
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
|
|
BENZODIAZEPINES 13 OR MORE
|
Facility
|
OP
|
$31.94
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
3008034701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna of VT Commercial |
$30.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$19.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$25.39
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cigna Commercial |
$25.55
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.55
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.55
|
| Rate for Payer: Martins Point Health Care Commercial |
$14.37
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$30.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.37
|
| Rate for Payer: United Healthcare VA CCN |
$14.37
|
|
|
BENZODIAZEPINES 13 OR MORE
|
Professional
|
Both
|
$31.94
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
3008034701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$863.35 |
| Rate for Payer: Aetna of VT Commercial |
$30.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$28.62
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$23.04
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$23.04
|
| Rate for Payer: Martins Point Health Care Commercial |
$863.35
|
| Rate for Payer: Multiplan Commercial |
$29.70
|
| Rate for Payer: United Healthcare Commercial |
$27.15
|
| Rate for Payer: United Healthcare VA CCN |
$12.78
|
|
|
BETA-2 GLYCOPROTEIN ANTIBODY
|
Facility
|
OP
|
$169.62
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
3008614601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$161.14 |
| Rate for Payer: Aetna of VT Commercial |
$161.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$102.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$137.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.85
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cigna Commercial |
$135.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$135.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$135.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$76.33
|
| Rate for Payer: Multiplan Commercial |
$157.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$76.33
|
| Rate for Payer: United Healthcare Commercial |
$161.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$76.33
|
|
|
BETA-2 GLYCOPROTEIN ANTIBODY
|
Facility
|
IP
|
$169.62
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
3008614601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.54 |
| Max. Negotiated Rate |
$161.14 |
| Rate for Payer: Aetna of VT Commercial |
$161.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$144.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$135.70
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cigna Commercial |
$135.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$135.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$135.70
|
| Rate for Payer: Multiplan Commercial |
$157.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$144.18
|
| Rate for Payer: United Healthcare Commercial |
$161.14
|
|
|
BETA-2 GLYCOPROTEIN ANTIBODY
|
Professional
|
Both
|
$169.62
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
3008614601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$159.44 |
| Rate for Payer: Aetna of VT Commercial |
$159.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.00
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cash Price |
$84.81
|
| Rate for Payer: Cigna Commercial |
$30.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.09
|
| Rate for Payer: Multiplan Commercial |
$157.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$25.45
|
|
|
BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$119.43
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
3008223201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.39 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna of VT Commercial |
$113.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$88.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$88.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$95.54
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cigna Commercial |
$95.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.54
|
| Rate for Payer: Multiplan Commercial |
$111.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.52
|
| Rate for Payer: United Healthcare Commercial |
$113.46
|
|
|
BETA-2 MICROGLOBULIN
|
Professional
|
Both
|
$119.43
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
3008223201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$112.26 |
| Rate for Payer: Aetna of VT Commercial |
$112.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$27.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$27.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.65
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cigna Commercial |
$19.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.95
|
| Rate for Payer: Multiplan Commercial |
$111.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare Commercial |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare VA CCN |
$16.18
|
|
|
BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$119.43
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
3008223201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna of VT Commercial |
$113.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$79.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$79.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$71.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.95
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Cigna Commercial |
$95.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$95.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$95.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.74
|
| Rate for Payer: Multiplan Commercial |
$111.07
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.74
|
| Rate for Payer: United Healthcare Commercial |
$113.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare VA CCN |
$53.74
|
|
|
BETA-AMYLOID 1-42 (ABETA 42)
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 82234
|
| Hospital Charge Code |
3008223401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,612.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,612.62
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: United Healthcare Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare VA CCN |
$720.00
|
|
