|
BLOOD SMEAR INTERPRETATION
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
3008506001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.13 |
| 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 |
$112.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$227.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$308.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$436.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$415.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$230.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$407.83
|
| Rate for Payer: Cash Price |
$256.50
|
| 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: Martins Point Health Care Commercial |
$230.85
|
| Rate for Payer: Multiplan Commercial |
$477.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$436.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$230.85
|
| Rate for Payer: United Healthcare Commercial |
$487.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.13
|
| Rate for Payer: United Healthcare VA CCN |
$230.85
|
|
|
BLOOD SMEAR INTERPRETATION
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
3008506001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$482.22 |
| Rate for Payer: Aetna of VT Commercial |
$482.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$112.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$112.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.21
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$27.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$477.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.13
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.13
|
| Rate for Payer: United Healthcare Commercial |
$34.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.13
|
| Rate for Payer: United Healthcare VA CCN |
$22.13
|
|
|
BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,185.22
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$524.93 |
| Max. Negotiated Rate |
$1,125.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,125.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,061.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$524.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,061.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$713.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,007.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$960.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$533.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$942.25
|
| Rate for Payer: Cash Price |
$592.61
|
| Rate for Payer: Cigna Commercial |
$948.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$948.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$948.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$533.35
|
| Rate for Payer: Multiplan Commercial |
$1,102.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,007.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$533.35
|
| Rate for Payer: United Healthcare Commercial |
$1,125.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$533.35
|
| Rate for Payer: United Healthcare VA CCN |
$533.35
|
|
|
BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,185.22
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$877.18 |
| Max. Negotiated Rate |
$1,125.96 |
| Rate for Payer: Aetna of VT Commercial |
$1,125.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$877.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$877.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,007.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$995.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$948.18
|
| Rate for Payer: Cash Price |
$592.61
|
| Rate for Payer: Cigna Commercial |
$948.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$948.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$948.18
|
| Rate for Payer: Multiplan Commercial |
$1,102.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,007.44
|
| Rate for Payer: United Healthcare Commercial |
$1,125.96
|
|
|
BLOOD TYPE ANTIGEN DONOR EA
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of VT Commercial |
$131.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$61.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$83.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$112.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.23
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cigna Commercial |
$110.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.92
|
| Rate for Payer: Martins Point Health Care Commercial |
$62.39
|
| Rate for Payer: Multiplan Commercial |
$128.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$62.39
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare VA CCN |
$62.39
|
|
|
BLOOD TYPE ANTIGEN DONOR EA
|
Professional
|
Both
|
$138.65
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$130.33 |
| Rate for Payer: Aetna of VT Commercial |
$130.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$6.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.23
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$128.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$9.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare VA CCN |
$6.35
|
|
|
BLOOD TYPE ANTIGEN DONOR EA
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$131.72 |
| Rate for Payer: Aetna of VT Commercial |
$131.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$102.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$102.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$117.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$116.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$110.92
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cigna Commercial |
$110.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$110.92
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$110.92
|
| Rate for Payer: Multiplan Commercial |
$128.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.85
|
| Rate for Payer: United Healthcare Commercial |
$131.72
|
|
|
BLOOD TYPING SEROLOGIC ABO
|
Professional
|
Both
|
$144.76
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$136.07 |
| Rate for Payer: Aetna of VT Commercial |
$136.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.35
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$4.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare VA CCN |
$2.99
|
|
|
BLOOD TYPING SEROLOGIC ABO
|
Facility
|
OP
|
$144.76
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna of VT Commercial |
$137.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$64.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$87.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$117.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.08
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.14
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.14
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare VA CCN |
$65.14
|
|
|
BLOOD TYPING SEROLOGIC ABO
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna of VT Commercial |
$137.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$107.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$107.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$121.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.81
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cigna Commercial |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$115.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$115.81
|
| Rate for Payer: Multiplan Commercial |
$134.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.05
|
| Rate for Payer: United Healthcare Commercial |
$137.52
|
|
|
BLOOD TYPING SEROLOGIC RH(D)
|
Professional
|
Both
|
$82.72
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna of VT Commercial |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.35
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2.99
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$4.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare VA CCN |
$2.99
|
|
|
BLOOD TYPING SEROLOGIC RH(D)
|
Facility
|
IP
|
$82.72
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$69.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$66.18
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
|
|
BLOOD TYPING SEROLOGIC RH(D)
|
Facility
|
OP
|
$82.72
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$78.58 |
| Rate for Payer: Aetna of VT Commercial |
$78.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$65.76
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cigna Commercial |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$66.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$66.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$76.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$37.22
|
| Rate for Payer: United Healthcare Commercial |
$78.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: United Healthcare VA CCN |
$37.22
|
|
|
BL SMEAR W/O DIFF WBC COUNT
|
Facility
|
OP
|
$31.02
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
3008500801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$16.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.66
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.37
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$13.96
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.43
|
| Rate for Payer: United Healthcare VA CCN |
$13.96
|
|
|
BL SMEAR W/O DIFF WBC COUNT
|
Facility
|
IP
|
$31.02
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
3008500801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: Aetna of VT Commercial |
$29.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$26.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$26.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.82
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cigna Commercial |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$24.82
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$28.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.37
|
| Rate for Payer: United Healthcare Commercial |
$29.47
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
IP
|
$86.64
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: Aetna of VT Commercial |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.31
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cigna Commercial |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.31
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.64
|
| Rate for Payer: United Healthcare Commercial |
$82.31
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
OP
|
$86.64
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
3008905001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: Aetna of VT Commercial |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$23.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$23.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.88
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cigna Commercial |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.99
|
| Rate for Payer: United Healthcare Commercial |
$82.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: United Healthcare VA CCN |
$38.99
|
|
|
BODY FLUID CELL COUNT W/ DIFFE
|
Facility
|
OP
|
$86.64
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
3008905101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: Aetna of VT Commercial |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$52.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$70.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$38.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$68.88
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cigna Commercial |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$38.99
|
| Rate for Payer: United Healthcare Commercial |
$82.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Healthcare VA CCN |
$38.99
|
|
|
BODY FLUID CELL COUNT W/ DIFFE
|
Facility
|
IP
|
$86.64
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
3008905101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: Aetna of VT Commercial |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$64.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$72.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$69.31
|
| Rate for Payer: Cash Price |
$43.32
|
| Rate for Payer: Cigna Commercial |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$69.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$69.31
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.64
|
| Rate for Payer: United Healthcare Commercial |
$82.31
|
|
|
BONE BIOPSY TROCAR/NEEDLE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
9822022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$318.24 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$318.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$344.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
|
|
BONE BIOPSY TROCAR/NEEDLE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
9822022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna of VT Commercial |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$341.85
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$344.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$344.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$365.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare Commercial |
$408.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.50
|
| Rate for Payer: United Healthcare VA CCN |
$193.50
|
|
|
BONE BIOPSY TROCAR/NEEDLE
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
9822022001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$414.71 |
| Rate for Payer: Aetna of VT Commercial |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$83.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$113.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.71
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$153.77
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.72
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.72
|
| Rate for Payer: Martins Point Health Care Commercial |
$216.34
|
| Rate for Payer: Multiplan Commercial |
$399.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$115.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$81.11
|
| Rate for Payer: United Healthcare Commercial |
$124.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.11
|
| Rate for Payer: United Healthcare VA CCN |
$81.11
|
|
|
BONE FENESTRATION PERFORATOR
|
Facility
|
OP
|
$256.43
|
|
| Hospital Charge Code |
2720069501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.86
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.39
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.39
|
| Rate for Payer: United Healthcare VA CCN |
$115.39
|
|
|
BONE FENESTRATION PERFORATOR
|
Facility
|
IP
|
$256.43
|
|
| Hospital Charge Code |
2720069501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.78 |
| Max. Negotiated Rate |
$243.61 |
| Rate for Payer: Aetna of VT Commercial |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.14
|
| Rate for Payer: Cash Price |
$128.22
|
| Rate for Payer: Cigna Commercial |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.14
|
| Rate for Payer: Multiplan Commercial |
$238.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.97
|
| Rate for Payer: United Healthcare Commercial |
$243.61
|
|
|
BONE IMAGING 3 PHASE
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
9727831501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$134.85 |
| Max. Negotiated Rate |
$1,167.76 |
| Rate for Payer: Aetna of VT Commercial |
$136.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$306.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,167.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$416.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$464.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$464.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$342.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$464.67
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$461.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$478.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$478.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$297.56
|
| Rate for Payer: Multiplan Commercial |
$134.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.56
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$297.56
|
| Rate for Payer: United Healthcare Commercial |
$457.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.56
|
| Rate for Payer: United Healthcare VA CCN |
$297.56
|
|
