|
TC99M Medronate up to 30 MCI
|
Facility
|
IP
|
$205.77
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
343A950301
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$152.29 |
| Max. Negotiated Rate |
$195.48 |
| Rate for Payer: Aetna of VT Commercial |
$195.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$152.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$172.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$164.62
|
| Rate for Payer: Cash Price |
$102.89
|
| Rate for Payer: Cigna Commercial |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$164.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$191.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$174.90
|
| Rate for Payer: United Healthcare Commercial |
$195.48
|
|
|
TC99M OXIDRONATE
|
Facility
|
IP
|
$272.02
|
|
|
Service Code
|
HCPCS A9561
|
| Hospital Charge Code |
343A956101
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of VT Commercial |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$201.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$201.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$217.62
|
| Rate for Payer: Cash Price |
$136.01
|
| Rate for Payer: Cigna Commercial |
$217.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$252.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.22
|
| Rate for Payer: United Healthcare Commercial |
$258.42
|
|
|
TC99M OXIDRONATE
|
Facility
|
OP
|
$272.02
|
|
|
Service Code
|
HCPCS A9561
|
| Hospital Charge Code |
343A956101
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$258.42 |
| Rate for Payer: Aetna of VT Commercial |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$120.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$220.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$122.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.26
|
| Rate for Payer: Cash Price |
$136.01
|
| Rate for Payer: Cigna Commercial |
$217.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$217.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$217.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$122.41
|
| Rate for Payer: Multiplan Commercial |
$252.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$231.22
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$122.41
|
| Rate for Payer: United Healthcare Commercial |
$258.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.41
|
| Rate for Payer: United Healthcare VA CCN |
$122.41
|
|
|
TC99M PYROPHOSPHATE
|
Facility
|
OP
|
$197.37
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
343A953801
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna of VT Commercial |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$118.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.91
|
| Rate for Payer: Cash Price |
$98.68
|
| Rate for Payer: Cigna Commercial |
$157.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$88.82
|
| Rate for Payer: Multiplan Commercial |
$183.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$88.82
|
| Rate for Payer: United Healthcare Commercial |
$187.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.82
|
| Rate for Payer: United Healthcare VA CCN |
$88.82
|
|
|
TC99M PYROPHOSPHATE
|
Facility
|
IP
|
$197.37
|
|
|
Service Code
|
HCPCS A9538
|
| Hospital Charge Code |
343A953801
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna of VT Commercial |
$187.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.90
|
| Rate for Payer: Cash Price |
$98.68
|
| Rate for Payer: Cigna Commercial |
$157.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$157.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$157.90
|
| Rate for Payer: Multiplan Commercial |
$183.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$167.76
|
| Rate for Payer: United Healthcare Commercial |
$187.50
|
|
|
TC99M Sulfur Colloid
|
Facility
|
IP
|
$584.21
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
343A954101
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$432.37 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of VT Commercial |
$555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$432.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$432.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$467.37
|
| Rate for Payer: Cash Price |
$292.10
|
| Rate for Payer: Cigna Commercial |
$467.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.37
|
| Rate for Payer: Multiplan Commercial |
$543.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.58
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
|
|
TC99M Sulfur Colloid
|
Facility
|
OP
|
$584.21
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
343A954101
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$258.75 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna of VT Commercial |
$555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$523.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$258.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$523.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$351.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$496.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$473.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$262.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.45
|
| Rate for Payer: Cash Price |
$292.10
|
| Rate for Payer: Cigna Commercial |
$467.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$467.37
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$467.37
|
| Rate for Payer: Martins Point Health Care Commercial |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$543.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$262.89
|
| Rate for Payer: United Healthcare Commercial |
$555.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.89
|
| Rate for Payer: United Healthcare VA CCN |
$262.89
|
|
|
TC99M Thallium
|
Facility
|
OP
|
$70.31
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
343A950501
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$66.79 |
| Rate for Payer: Aetna of VT Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.90
|
| Rate for Payer: Cash Price |
$35.16
|
| Rate for Payer: Cigna Commercial |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.64
|
| Rate for Payer: Multiplan Commercial |
$65.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.64
|
| Rate for Payer: United Healthcare Commercial |
$66.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.64
|
| Rate for Payer: United Healthcare VA CCN |
$31.64
|
|
|
TC99M Thallium
|
Facility
|
IP
|
$70.31
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
343A950501
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$66.79 |
| Rate for Payer: Aetna of VT Commercial |
$66.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$52.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$52.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.25
|
| Rate for Payer: Cash Price |
$35.16
|
| Rate for Payer: Cigna Commercial |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$65.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.76
|
| Rate for Payer: United Healthcare Commercial |
$66.79
|
|
|
TC99 Sestamibi
|
Facility
|
OP
|
$270.91
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna of VT Commercial |
$257.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$163.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.37
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cigna Commercial |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.91
|
| Rate for Payer: Multiplan Commercial |
$251.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.91
|
| Rate for Payer: United Healthcare Commercial |
$257.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.91
|
| Rate for Payer: United Healthcare VA CCN |
$121.91
|
|
|
TC99 Sestamibi
|
Facility
|
IP
|
$270.91
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
343A950001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$200.50 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna of VT Commercial |
$257.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$200.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$200.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$230.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$227.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.73
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cigna Commercial |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.73
|
| Rate for Payer: Multiplan Commercial |
$251.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$230.27
|
| Rate for Payer: United Healthcare Commercial |
$257.36
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
OP
|
$229.82
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
3008636001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$231.49 |
| Rate for Payer: Aetna of VT Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.71
|
| Rate for Payer: Cash Price |
$114.91
|
| Rate for Payer: Cash Price |
$114.91
|
| Rate for Payer: Cigna Commercial |
$183.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.86
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.42
|
| Rate for Payer: Multiplan Commercial |
$213.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.42
|
| Rate for Payer: United Healthcare Commercial |
$218.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare VA CCN |
$103.42
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Facility
|
IP
|
$229.82
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
3008636001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.09 |
| Max. Negotiated Rate |
$218.33 |
| Rate for Payer: Aetna of VT Commercial |
$218.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$183.86
|
| Rate for Payer: Cash Price |
$114.91
|
| Rate for Payer: Cigna Commercial |
$183.86
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$183.86
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$183.86
|
| Rate for Payer: Multiplan Commercial |
$213.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.35
|
| Rate for Payer: United Healthcare Commercial |
$218.33
|
|
|
T CELL ABSOLUTE COUNT/RATIO
|
Professional
|
Both
|
$229.82
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
3008636001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$231.49 |
| Rate for Payer: Aetna of VT Commercial |
$216.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$48.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$65.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$54.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.61
|
| Rate for Payer: Cash Price |
$114.91
|
| Rate for Payer: Cash Price |
$114.91
|
| Rate for Payer: Cigna Commercial |
$56.72
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$46.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$46.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$213.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.98
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$72.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare VA CCN |
$46.98
|
|
|
T CELLS TOTAL COUNT
|
Professional
|
Both
|
$203.70
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
3008635901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$191.48 |
| Rate for Payer: Aetna of VT Commercial |
$191.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$51.89
|
| Rate for Payer: Cash Price |
$101.85
|
| Rate for Payer: Cash Price |
$101.85
|
| Rate for Payer: Cigna Commercial |
$45.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$37.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$37.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$189.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.73
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$37.73
|
|
|
T CELLS TOTAL COUNT
|
Facility
|
OP
|
$203.70
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
3008635901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$193.51 |
| Rate for Payer: Aetna of VT Commercial |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$90.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$122.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$161.94
|
| Rate for Payer: Cash Price |
$101.85
|
| Rate for Payer: Cash Price |
$101.85
|
| Rate for Payer: Cigna Commercial |
$162.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$91.67
|
| Rate for Payer: Multiplan Commercial |
$189.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$91.67
|
| Rate for Payer: United Healthcare Commercial |
$193.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare VA CCN |
$91.67
|
|
|
T CELLS TOTAL COUNT
|
Facility
|
IP
|
$203.70
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
3008635901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.76 |
| Max. Negotiated Rate |
$193.51 |
| Rate for Payer: Aetna of VT Commercial |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$173.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$171.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.96
|
| Rate for Payer: Cash Price |
$101.85
|
| Rate for Payer: Cigna Commercial |
$162.96
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$162.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$162.96
|
| Rate for Payer: Multiplan Commercial |
$189.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$173.15
|
| Rate for Payer: United Healthcare Commercial |
$193.51
|
|
|
TEAM CONF W/O PAT BY HC PRO
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 99368
|
| Hospital Charge Code |
9699936801
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$278.28 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna of VT Commercial |
$357.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$278.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$278.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$315.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$300.80
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$300.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$300.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$300.80
|
| Rate for Payer: Multiplan Commercial |
$349.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$319.60
|
| Rate for Payer: United Healthcare Commercial |
$357.20
|
|
|
TEAM CONF W/O PAT BY HC PRO
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 99368
|
| Hospital Charge Code |
9699936801
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$166.53 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna of VT Commercial |
$357.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$336.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$336.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$226.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$319.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$304.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$298.92
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cigna Commercial |
$300.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$300.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$300.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$349.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$319.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$169.20
|
| Rate for Payer: United Healthcare Commercial |
$357.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.20
|
| Rate for Payer: United Healthcare VA CCN |
$169.20
|
|
|
TEAM CONF W/O PAT BY PHYS
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
9699936701
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$152.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
|
|
TEAM CONF W/O PAT BY PHYS
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 99367
|
| Hospital Charge Code |
9699936701
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna of VT Commercial |
$180.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$84.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$151.05
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$152.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$152.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$176.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$180.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.50
|
| Rate for Payer: United Healthcare VA CCN |
$85.50
|
|
|
TEAM CONF W/PAT BY HC PROF
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 99366
|
| Hospital Charge Code |
9699936601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$141.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$134.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
|
|
TEAM CONF W/PAT BY HC PROF
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 99366
|
| Hospital Charge Code |
9699936601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna of VT Commercial |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$150.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.56
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$134.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$134.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$156.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare Commercial |
$159.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.60
|
| Rate for Payer: United Healthcare VA CCN |
$75.60
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
5103760901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,434.80 |
| Max. Negotiated Rate |
$4,408.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,408.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,434.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,434.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,944.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,898.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,320.50
|
| Rate for Payer: Cigna Commercial |
$3,712.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,712.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,712.80
|
| Rate for Payer: Multiplan Commercial |
$4,316.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,944.85
|
| Rate for Payer: United Healthcare Commercial |
$4,408.95
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
9603760902
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$663.64 |
| Rate for Payer: Aetna of VT Commercial |
$663.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$192.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$632.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$261.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$490.90
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cash Price |
$353.00
|
| Rate for Payer: Cigna Commercial |
$344.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$471.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$471.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.40
|
| Rate for Payer: Multiplan Commercial |
$656.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare Commercial |
$287.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.79
|
| Rate for Payer: United Healthcare VA CCN |
$186.79
|
|
