|
CALCIUM IONIZED
|
Facility
|
OP
|
$225.72
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3008233001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$214.43 |
| Rate for Payer: Aetna of VT Commercial |
$214.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$67.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$101.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$179.45
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cigna Commercial |
$180.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$180.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$180.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$101.57
|
| Rate for Payer: Multiplan Commercial |
$209.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$191.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$101.57
|
| Rate for Payer: United Healthcare Commercial |
$214.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare VA CCN |
$101.57
|
|
|
CALCIUM TOTAL
|
Facility
|
OP
|
$68.45
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
3008231001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$65.03 |
| Rate for Payer: Aetna of VT Commercial |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$25.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$25.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.42
|
| Rate for Payer: Cash Price |
$34.23
|
| Rate for Payer: Cash Price |
$34.23
|
| Rate for Payer: Cigna Commercial |
$54.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.80
|
| Rate for Payer: Multiplan Commercial |
$63.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$65.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Healthcare VA CCN |
$30.80
|
|
|
CALCIUM TOTAL
|
Facility
|
IP
|
$68.45
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
3008231001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.66 |
| Max. Negotiated Rate |
$65.03 |
| Rate for Payer: Aetna of VT Commercial |
$65.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$50.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$50.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.76
|
| Rate for Payer: Cash Price |
$34.23
|
| Rate for Payer: Cigna Commercial |
$54.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$54.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$54.76
|
| Rate for Payer: Multiplan Commercial |
$63.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.18
|
| Rate for Payer: United Healthcare Commercial |
$65.03
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Professional
|
Both
|
$156.13
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
3008236501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna of VT Commercial |
$146.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$13.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$22.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$22.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.72
|
| Rate for Payer: Multiplan Commercial |
$145.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare Commercial |
$19.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare VA CCN |
$12.90
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Facility
|
IP
|
$156.13
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
3008236501
|
|
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
|
|
|
CALCULUS INFRARED SPECTROSCOPY
|
Facility
|
OP
|
$156.13
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
3008236501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| 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 |
$63.56
|
| 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 |
$63.56
|
| 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 |
$12.90
|
| Rate for Payer: United Healthcare VA CCN |
$70.26
|
|
|
CALR GENE COM VARIANTS
|
Facility
|
OP
|
$865.44
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
3008121901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$822.17 |
| Rate for Payer: Aetna of VT Commercial |
$822.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$599.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$383.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$599.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$520.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$735.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$389.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$688.02
|
| Rate for Payer: Cash Price |
$432.72
|
| Rate for Payer: Cash Price |
$432.72
|
| Rate for Payer: Cigna Commercial |
$692.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$692.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$692.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$389.45
|
| Rate for Payer: Multiplan Commercial |
$804.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$735.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$389.45
|
| Rate for Payer: United Healthcare Commercial |
$822.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: United Healthcare VA CCN |
$389.45
|
|
|
CALR GENE COM VARIANTS
|
Facility
|
IP
|
$865.44
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
3008121901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$640.51 |
| Max. Negotiated Rate |
$822.17 |
| Rate for Payer: Aetna of VT Commercial |
$822.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$640.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$640.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$735.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$726.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$692.35
|
| Rate for Payer: Cash Price |
$432.72
|
| Rate for Payer: Cigna Commercial |
$692.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$692.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$692.35
|
| Rate for Payer: Multiplan Commercial |
$804.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$735.62
|
| Rate for Payer: United Healthcare Commercial |
$822.17
|
|
|
CALR GENE COM VARIANTS
|
Professional
|
Both
|
$865.44
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
3008121901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.93 |
| Max. Negotiated Rate |
$813.51 |
| Rate for Payer: Aetna of VT Commercial |
$813.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$599.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$599.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$170.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$195.30
|
| Rate for Payer: Cash Price |
$432.72
|
| Rate for Payer: Cash Price |
$432.72
|
| Rate for Payer: Cigna Commercial |
$147.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$121.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$121.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.93
|
| Rate for Payer: Multiplan Commercial |
$804.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.63
|
| Rate for Payer: United Healthcare Commercial |
$187.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: United Healthcare VA CCN |
$121.63
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
9699599201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$131.86
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$97.59 |
| Max. Negotiated Rate |
$125.27 |
| Rate for Payer: Aetna of VT Commercial |
$125.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$97.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$97.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$110.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$105.49
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cigna Commercial |
$105.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.49
|
| Rate for Payer: Multiplan Commercial |
$122.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.08
|
| Rate for Payer: United Healthcare Commercial |
$125.27
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$131.86
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
4209599201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$125.27 |
| Rate for Payer: Aetna of VT Commercial |
$125.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.83
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cigna Commercial |
$105.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.34
|
| Rate for Payer: Multiplan Commercial |
$122.63
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.84
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.34
|
| Rate for Payer: United Healthcare Commercial |
$125.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.34
|
| Rate for Payer: United Healthcare VA CCN |
$59.34
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
9699599201
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna of VT Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$58.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$118.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$79.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$106.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.94
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$105.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$105.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$59.40
|
| Rate for Payer: Multiplan Commercial |
$122.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$112.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.40
|
| Rate for Payer: United Healthcare VA CCN |
$59.40
|
|
|
CANDIDA DNA AMP PROBE
|
Professional
|
Both
|
$41.36
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
3008748101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$36.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$49.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$59.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$59.98
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$42.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$35.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$35.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$53.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$35.09
|
|
|
CANDIDA DNA AMP PROBE
|
Facility
|
IP
|
$41.36
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
3008748101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$39.29 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$30.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$34.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$33.09
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
|
|
CANDIDA DNA AMP PROBE
|
Facility
|
OP
|
$41.36
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
3008748101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna of VT Commercial |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$18.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$172.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$33.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$18.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.88
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna Commercial |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$33.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$33.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.61
|
| Rate for Payer: Multiplan Commercial |
$38.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.16
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.61
|
| Rate for Payer: United Healthcare Commercial |
$39.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare VA CCN |
$18.61
|
|
|
CANISTR PRTBL ACTIVAC/WGEL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
2720074611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna of VT Commercial |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.60
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$34.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
|
|
CANISTR PRTBL ACTIVAC/WGEL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
2720074611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna of VT Commercial |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$33.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$22.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$29.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$29.41
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$29.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$29.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.65
|
| Rate for Payer: Multiplan Commercial |
$34.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.65
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.65
|
| Rate for Payer: United Healthcare VA CCN |
$16.65
|
|
|
CANNABINOIDS NATURAL
|
Professional
|
Both
|
$227.48
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
3008034901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$213.83 |
| Rate for Payer: Aetna of VT Commercial |
$213.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cigna Commercial |
$29.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$13.42
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$13.42
|
| Rate for Payer: Martins Point Health Care Commercial |
$127.04
|
| Rate for Payer: Multiplan Commercial |
$211.56
|
| Rate for Payer: United Healthcare Commercial |
$193.36
|
| Rate for Payer: United Healthcare VA CCN |
$90.99
|
|
|
CANNABINOIDS NATURAL
|
Facility
|
IP
|
$227.48
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
3008034901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$216.11 |
| Rate for Payer: Aetna of VT Commercial |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$191.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$181.98
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cigna Commercial |
$181.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.98
|
| Rate for Payer: Multiplan Commercial |
$211.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.36
|
| Rate for Payer: United Healthcare Commercial |
$216.11
|
|
|
CANNABINOIDS NATURAL
|
Facility
|
OP
|
$227.48
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
3008034901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$216.11 |
| Rate for Payer: Aetna of VT Commercial |
$216.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$100.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$136.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$193.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$102.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$180.85
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cigna Commercial |
$181.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$181.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$181.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.37
|
| Rate for Payer: Multiplan Commercial |
$211.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$193.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$102.37
|
| Rate for Payer: United Healthcare Commercial |
$216.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.37
|
| Rate for Payer: United Healthcare VA CCN |
$102.37
|
|
|
CANN NASAL ADULT CO2 W/O2
|
Facility
|
IP
|
$19.36
|
|
| Hospital Charge Code |
2700033781
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna of VT Commercial |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.49
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cigna Commercial |
$15.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$18.39
|
|
|
CANN NASAL ADULT CO2 W/O2
|
Facility
|
OP
|
$19.36
|
|
| Hospital Charge Code |
2700033781
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna of VT Commercial |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$8.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$15.39
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cigna Commercial |
$15.49
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$15.49
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$15.49
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.71
|
| Rate for Payer: United Healthcare Commercial |
$18.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.71
|
| Rate for Payer: United Healthcare VA CCN |
$8.71
|
|
|
CAN SHT THD SCW HD 4X22MM
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.89 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna of VT Commercial |
$442.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$344.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$396.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$391.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.80
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$372.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$372.80
|
| Rate for Payer: Multiplan Commercial |
$433.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.10
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
|
|
CAN SHT THD SCW HD 4X22MM
|
Facility
|
IP
|
$330.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2780073881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.73 |
| Max. Negotiated Rate |
$314.14 |
| Rate for Payer: Aetna of VT Commercial |
$314.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$281.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$277.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$264.54
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cigna Commercial |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$264.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$264.54
|
| Rate for Payer: Multiplan Commercial |
$307.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$281.07
|
| Rate for Payer: United Healthcare Commercial |
$314.14
|
|
