|
CAPILLARY BLOOD DRAW
|
Facility
|
OP
|
$23.78
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
4503641601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$10.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$10.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$18.91
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$10.70
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.70
|
| Rate for Payer: United Healthcare VA CCN |
$10.70
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
3003641601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of VT Commercial |
$22.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$19.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$19.02
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna Commercial |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$19.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$22.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.21
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
|
CAPILLARY BLOOD DRAW
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
9813641602
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna of VT Commercial |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$9.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$17.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$17.49
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$17.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$17.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$9.90
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.90
|
| Rate for Payer: United Healthcare VA CCN |
$9.90
|
|
|
CARBIDOPA/LEVODOPA 25/100 IR
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 5965145701
|
| Hospital Charge Code |
2500000561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of VT Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.03
|
|
|
CARBIDOPA/LEVODOPA 25/100 IR
|
Facility
|
OP
|
$0.06
|
|
| Hospital Charge Code |
2500000561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of VT Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.03
|
| Rate for Payer: United Healthcare VA CCN |
$0.03
|
|
|
CARBIDOPA/LEVODOPA 25/100 IR
|
Facility
|
IP
|
$0.06
|
|
| Hospital Charge Code |
2500000561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of VT Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
|
|
CARBIDOPA/LEVODOPA 25/100 IR
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 5965145701
|
| Hospital Charge Code |
2500000561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of VT Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
|
|
CARBON DIOXIDE BICARBONATE
|
Facility
|
IP
|
$50.58
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
3008237401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.43 |
| Max. Negotiated Rate |
$48.05 |
| Rate for Payer: Aetna of VT Commercial |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$42.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.46
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cigna Commercial |
$40.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.46
|
| Rate for Payer: Multiplan Commercial |
$47.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.99
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
|
|
CARBON DIOXIDE BICARBONATE
|
Facility
|
OP
|
$50.58
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
3008237401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$48.05 |
| Rate for Payer: Aetna of VT Commercial |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$22.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$24.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.21
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cigna Commercial |
$40.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$40.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$40.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.76
|
| Rate for Payer: Multiplan Commercial |
$47.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.76
|
| Rate for Payer: United Healthcare Commercial |
$48.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: United Healthcare VA CCN |
$22.76
|
|
|
CARBOXYHEMOGLOBIN QUANTITATIVE
|
Facility
|
IP
|
$162.34
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
3008237501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.15 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna of VT Commercial |
$154.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$120.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$136.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.87
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cigna Commercial |
$129.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.87
|
| Rate for Payer: Multiplan Commercial |
$150.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.99
|
| Rate for Payer: United Healthcare Commercial |
$154.22
|
|
|
CARBOXYHEMOGLOBIN QUANTITATIVE
|
Facility
|
OP
|
$162.34
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
3008237501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna of VT Commercial |
$154.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$71.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$97.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$137.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$73.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.06
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cigna Commercial |
$129.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$129.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$129.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$73.05
|
| Rate for Payer: Multiplan Commercial |
$150.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$73.05
|
| Rate for Payer: United Healthcare Commercial |
$154.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare VA CCN |
$73.05
|
|
|
CARBOXYHEMOGLOBIN QUANTITATIVE
|
Professional
|
Both
|
$162.34
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
3008237501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$152.60 |
| Rate for Payer: Aetna of VT Commercial |
$152.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$21.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$21.06
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cigna Commercial |
$15.07
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$12.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$12.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$150.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.32
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$18.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare VA CCN |
$12.32
|
|
|
CARCINOEMBRYONIC ANTIGEN CEA
|
Facility
|
IP
|
$242.77
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
3008237801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.67 |
| Max. Negotiated Rate |
$230.63 |
| Rate for Payer: Aetna of VT Commercial |
$230.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$179.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$179.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$203.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$194.22
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.22
|
| Rate for Payer: Multiplan Commercial |
$225.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.35
|
| Rate for Payer: United Healthcare Commercial |
$230.63
|
|
|
CARCINOEMBRYONIC ANTIGEN CEA
|
Facility
|
OP
|
$242.77
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
3008237801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$230.63 |
| Rate for Payer: Aetna of VT Commercial |
$230.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$146.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$206.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$193.00
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$194.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$194.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$109.25
|
| Rate for Payer: Multiplan Commercial |
$225.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$206.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$109.25
|
| Rate for Payer: United Healthcare Commercial |
$230.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare VA CCN |
$109.25
|
|
|
CARCINOEMBRYONIC ANTIGEN CEA
|
Professional
|
Both
|
$242.77
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
3008237801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$228.20 |
| Rate for Payer: Aetna of VT Commercial |
$228.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$93.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$26.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$32.40
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Cigna Commercial |
$23.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.69
|
| Rate for Payer: Multiplan Commercial |
$225.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.96
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$29.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare VA CCN |
$18.96
|
|
|
CARDIAC REHAB/MONITOR
|
Facility
|
OP
|
$270.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
9439379801
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$119.64 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.75
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cigna Commercial |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.56
|
| Rate for Payer: Multiplan Commercial |
$251.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.56
|
| Rate for Payer: United Healthcare Commercial |
$256.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.56
|
| Rate for Payer: United Healthcare VA CCN |
$121.56
|
|
|
CARDIAC REHAB/MONITOR
|
Facility
|
IP
|
$270.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
9439379801
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.10
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cigna Commercial |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.10
|
| Rate for Payer: Multiplan Commercial |
$251.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.61
|
| Rate for Payer: United Healthcare Commercial |
$256.62
|
|
|
CARDIAC REHAB/MONITOR READ
|
Facility
|
IP
|
$270.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
9609379801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$199.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$226.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$216.10
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cigna Commercial |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.10
|
| Rate for Payer: Multiplan Commercial |
$251.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.61
|
| Rate for Payer: United Healthcare Commercial |
$256.62
|
|
|
CARDIAC REHAB/MONITOR READ
|
Professional
|
Both
|
$270.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
9609379801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna of VT Commercial |
$253.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$17.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$14.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$40.50
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cigna Commercial |
$29.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.16
|
| Rate for Payer: Multiplan Commercial |
$251.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.89
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare Commercial |
$19.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare VA CCN |
$12.60
|
|
|
CARDIAC REHAB/MONITOR READ
|
Facility
|
OP
|
$270.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
9609379801
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$119.64 |
| Max. Negotiated Rate |
$256.62 |
| Rate for Payer: Aetna of VT Commercial |
$256.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$119.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$121.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$214.75
|
| Rate for Payer: Cash Price |
$135.06
|
| Rate for Payer: Cigna Commercial |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$216.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$216.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$121.56
|
| Rate for Payer: Multiplan Commercial |
$251.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$229.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$121.56
|
| Rate for Payer: United Healthcare Commercial |
$256.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.56
|
| Rate for Payer: United Healthcare VA CCN |
$121.56
|
|
|
CARDIAC REHAB W/O CONT ECG MON
|
Facility
|
IP
|
$178.88
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
9439379701
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna of VT Commercial |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$132.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$132.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$143.10
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cigna Commercial |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.10
|
| Rate for Payer: Multiplan Commercial |
$166.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.05
|
| Rate for Payer: United Healthcare Commercial |
$169.94
|
|
|
CARDIAC REHAB W/O CONT ECG MON
|
Facility
|
OP
|
$178.88
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
9439379701
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$79.23 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna of VT Commercial |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$107.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$142.21
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cigna Commercial |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$143.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$143.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$166.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$152.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$169.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.50
|
| Rate for Payer: United Healthcare VA CCN |
$80.50
|
|
|
CARDIOLIPIN ANTIBODY EA IG
|
Facility
|
IP
|
$218.93
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
3008614701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.03 |
| Max. Negotiated Rate |
$207.98 |
| Rate for Payer: Aetna of VT Commercial |
$207.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$183.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$175.14
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cigna Commercial |
$175.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.14
|
| Rate for Payer: Multiplan Commercial |
$203.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.09
|
| Rate for Payer: United Healthcare Commercial |
$207.98
|
|
|
CARDIOLIPIN ANTIBODY EA IG
|
Facility
|
OP
|
$218.93
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
3008614701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$207.98 |
| Rate for Payer: Aetna of VT Commercial |
$207.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$131.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$186.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$98.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$174.05
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cigna Commercial |
$175.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$175.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$175.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.52
|
| Rate for Payer: Multiplan Commercial |
$203.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.52
|
| Rate for Payer: United Healthcare Commercial |
$207.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$98.52
|
|
|
CARDIOLIPIN ANTIBODY EA IG
|
Professional
|
Both
|
$218.93
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
3008614701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Aetna of VT Commercial |
$205.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$125.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$35.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$35.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$35.00
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cigna Commercial |
$30.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$25.45
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$25.45
|
| Rate for Payer: Martins Point Health Care Commercial |
$25.09
|
| Rate for Payer: Multiplan Commercial |
$203.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare VA CCN |
$25.45
|
|
