|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
9813640001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of VT Commercial |
$74.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$69.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$66.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$63.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$35.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$62.01
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$62.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$62.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$72.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.10
|
| Rate for Payer: United Healthcare VA CCN |
$35.10
|
|
|
BL DRAW <3 YRS OTHER VEIN
|
Professional
|
Both
|
$268.84
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3003640601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$252.71 |
| Rate for Payer: Aetna of VT Commercial |
$252.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$44.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$44.61
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cigna Commercial |
$15.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$27.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$27.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$250.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$8.24
|
|
|
BL DRAW <3 YRS OTHER VEIN
|
Facility
|
OP
|
$268.84
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3003640601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$255.40 |
| Rate for Payer: Aetna of VT Commercial |
$255.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$240.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$161.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$213.73
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cigna Commercial |
$215.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$120.98
|
| Rate for Payer: Multiplan Commercial |
$250.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$120.98
|
| Rate for Payer: United Healthcare Commercial |
$255.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.24
|
| Rate for Payer: United Healthcare VA CCN |
$120.98
|
|
|
BL DRAW <3 YRS OTHER VEIN
|
Facility
|
IP
|
$268.84
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3003640601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$255.40 |
| Rate for Payer: Aetna of VT Commercial |
$255.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$198.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$198.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$225.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$215.07
|
| Rate for Payer: Cash Price |
$134.42
|
| Rate for Payer: Cigna Commercial |
$215.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$215.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$215.07
|
| Rate for Payer: Multiplan Commercial |
$250.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.51
|
| Rate for Payer: United Healthcare Commercial |
$255.40
|
|
|
BLD TYPING SEROLOGIC RH PHNT
|
Facility
|
OP
|
$88.01
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
3008690601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$83.61 |
| Rate for Payer: Aetna of VT Commercial |
$83.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$71.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.97
|
| Rate for Payer: Cash Price |
$44.01
|
| Rate for Payer: Cash Price |
$44.01
|
| Rate for Payer: Cigna Commercial |
$70.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.41
|
| Rate for Payer: Martins Point Health Care Commercial |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$81.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.81
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$83.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.75
|
| Rate for Payer: United Healthcare VA CCN |
$39.60
|
|
|
BLD TYPING SEROLOGIC RH PHNT
|
Facility
|
IP
|
$88.01
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
3008690601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$83.61 |
| Rate for Payer: Aetna of VT Commercial |
$83.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$74.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$73.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$70.41
|
| Rate for Payer: Cash Price |
$44.01
|
| Rate for Payer: Cigna Commercial |
$70.41
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$70.41
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$70.41
|
| Rate for Payer: Multiplan Commercial |
$81.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.81
|
| Rate for Payer: United Healthcare Commercial |
$83.61
|
|
|
BLD TYPING SEROLOGIC RH PHNT
|
Professional
|
Both
|
$88.01
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
3008690601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$82.73 |
| Rate for Payer: Aetna of VT Commercial |
$82.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$7.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$38.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$10.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$13.25
|
| Rate for Payer: Cash Price |
$44.01
|
| Rate for Payer: Cash Price |
$44.01
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$81.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$7.75
|
| Rate for Payer: United Healthcare Commercial |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.75
|
| Rate for Payer: United Healthcare VA CCN |
$7.75
|
|
|
BLOOC CLOT FACTOR V TEST
|
Facility
|
OP
|
$76.77
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
3008522001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$86.97 |
| Rate for Payer: Aetna of VT Commercial |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$34.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$62.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.03
|
| Rate for Payer: Cash Price |
$38.38
|
| Rate for Payer: Cash Price |
$38.38
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.55
|
| Rate for Payer: Multiplan Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.55
|
| Rate for Payer: United Healthcare Commercial |
$72.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare VA CCN |
$34.55
|
|
|
BLOOC CLOT FACTOR V TEST
|
Professional
|
Both
|
$76.77
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
3008522001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$86.97 |
| Rate for Payer: Aetna of VT Commercial |
$72.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$86.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$86.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$30.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$30.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$30.17
|
| Rate for Payer: Cash Price |
$38.38
|
| Rate for Payer: Cash Price |
$38.38
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.65
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.65
|
| Rate for Payer: Martins Point Health Care Commercial |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare Commercial |
$27.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare VA CCN |
$17.65
|
|
|
BLOOC CLOT FACTOR V TEST
|
Facility
|
IP
|
$76.77
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
3008522001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna of VT Commercial |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.42
|
| Rate for Payer: Cash Price |
$38.38
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.42
|
| Rate for Payer: Multiplan Commercial |
$71.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: United Healthcare Commercial |
$72.93
|
|
|
BLOOD COUNT HEMATOCRIT
|
Facility
|
IP
|
$35.06
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
3008501401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$33.31 |
| Rate for Payer: Aetna of VT Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$29.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.05
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.05
|
| Rate for Payer: Multiplan Commercial |
$32.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.80
|
| Rate for Payer: United Healthcare Commercial |
$33.31
|
|
|
BLOOD COUNT HEMATOCRIT
|
Facility
|
OP
|
$35.06
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
3008501401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$33.31 |
| Rate for Payer: Aetna of VT Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$29.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.87
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.78
|
| Rate for Payer: Multiplan Commercial |
$32.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.78
|
| Rate for Payer: United Healthcare Commercial |
$33.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare VA CCN |
$15.78
|
|
|
BLOOD COUNT HEMOGLOBIN
|
Facility
|
OP
|
$35.06
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
3008501801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$33.31 |
| Rate for Payer: Aetna of VT Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$15.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$21.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$29.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$27.87
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$15.78
|
| Rate for Payer: Multiplan Commercial |
$32.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$15.78
|
| Rate for Payer: United Healthcare Commercial |
$33.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare VA CCN |
$15.78
|
|
|
BLOOD COUNT HEMOGLOBIN
|
Facility
|
IP
|
$35.06
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
3008501801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$33.31 |
| Rate for Payer: Aetna of VT Commercial |
$33.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$29.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.05
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$28.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$28.05
|
| Rate for Payer: Multiplan Commercial |
$32.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.80
|
| Rate for Payer: United Healthcare Commercial |
$33.31
|
|
|
BLOOD COUNT PLATELET AUTOMATED
|
Facility
|
OP
|
$81.69
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
3008504901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$66.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$36.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$64.94
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$36.76
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$36.76
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.48
|
| Rate for Payer: United Healthcare VA CCN |
$36.76
|
|
|
BLOOD COUNT PLATELET AUTOMATED
|
Facility
|
IP
|
$81.69
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
3008504901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$77.61 |
| Rate for Payer: Aetna of VT Commercial |
$77.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$69.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$68.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.35
|
| Rate for Payer: Cash Price |
$40.84
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$65.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$65.35
|
| Rate for Payer: Multiplan Commercial |
$75.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.44
|
| Rate for Payer: United Healthcare Commercial |
$77.61
|
|
|
BLOOD CULTURE FOR BACTERIA
|
Facility
|
IP
|
$156.13
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
300870400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.55 |
| Max. Negotiated Rate |
$148.32 |
| Rate for Payer: Aetna of VT Commercial |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.90
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cigna Commercial |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.90
|
| Rate for Payer: Multiplan Commercial |
$145.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.71
|
| Rate for Payer: United Healthcare Commercial |
$148.32
|
|
|
BLOOD CULTURE FOR BACTERIA
|
Facility
|
OP
|
$156.13
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
300870400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$148.32 |
| Rate for Payer: Aetna of VT Commercial |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.12
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cigna Commercial |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.26
|
| Rate for Payer: Multiplan Commercial |
$145.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.26
|
| Rate for Payer: United Healthcare Commercial |
$148.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare VA CCN |
$70.26
|
|
|
BLOOD CULTURE FOR BACTERIA
|
Facility
|
IP
|
$156.13
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
3008704001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.55 |
| Max. Negotiated Rate |
$148.32 |
| Rate for Payer: Aetna of VT Commercial |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$115.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.90
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cigna Commercial |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.90
|
| Rate for Payer: Multiplan Commercial |
$145.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.71
|
| Rate for Payer: United Healthcare Commercial |
$148.32
|
|
|
BLOOD CULTURE FOR BACTERIA
|
Facility
|
OP
|
$156.13
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
3008704001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$148.32 |
| Rate for Payer: Aetna of VT Commercial |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$132.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$126.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.12
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cigna Commercial |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$124.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$124.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.26
|
| Rate for Payer: Multiplan Commercial |
$145.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.71
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.26
|
| Rate for Payer: United Healthcare Commercial |
$148.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare VA CCN |
$70.26
|
|
|
BLOOD GASES ANY COMBINATION
|
Facility
|
IP
|
$319.74
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3008280301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.64 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna of VT Commercial |
$303.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$268.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.79
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Cigna Commercial |
$255.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.79
|
| Rate for Payer: Multiplan Commercial |
$297.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.78
|
| Rate for Payer: United Healthcare Commercial |
$303.75
|
|
|
BLOOD GASES ANY COMBINATION
|
Facility
|
OP
|
$319.74
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
3008280301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna of VT Commercial |
$303.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$192.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$271.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$143.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$254.19
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Cash Price |
$159.87
|
| Rate for Payer: Cigna Commercial |
$255.79
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$255.79
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$255.79
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.88
|
| Rate for Payer: Multiplan Commercial |
$297.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$271.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.88
|
| Rate for Payer: United Healthcare Commercial |
$303.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare VA CCN |
$143.88
|
|
|
BLOOD GASES W/O2 SATURATION
|
Facility
|
IP
|
$200.60
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3008280501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna of VT Commercial |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$148.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$148.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$160.48
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cigna Commercial |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.48
|
| Rate for Payer: Multiplan Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$190.57
|
|
|
BLOOD GASES W/O2 SATURATION
|
Facility
|
OP
|
$200.60
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3008280501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$388.14 |
| Rate for Payer: Aetna of VT Commercial |
$190.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$388.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$388.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$120.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$90.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.48
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cigna Commercial |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$160.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$160.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.27
|
| Rate for Payer: Multiplan Commercial |
$186.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$170.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.27
|
| Rate for Payer: United Healthcare Commercial |
$190.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Healthcare VA CCN |
$90.27
|
|
|
BLOOD SMEAR INTERPRETATION
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
3008506001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$379.67 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Aetna of VT Commercial |
$487.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$379.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$379.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$430.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$410.40
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$410.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$410.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$410.40
|
| Rate for Payer: Multiplan Commercial |
$477.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$436.05
|
| Rate for Payer: United Healthcare Commercial |
$487.35
|
|
