|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$0.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$0.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.45
|
| Rate for Payer: United Healthcare VA CCN |
$0.45
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5101310201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$1,647.82 |
| Rate for Payer: Aetna of VT Commercial |
$1,647.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$1,630.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5101310201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$776.40 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,665.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$776.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,570.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,055.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$788.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,393.63
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cigna Commercial |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,402.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$788.85
|
| Rate for Payer: Multiplan Commercial |
$1,630.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,490.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$788.85
|
| Rate for Payer: United Healthcare Commercial |
$1,665.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$788.85
|
| Rate for Payer: United Healthcare VA CCN |
$788.85
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of VT Commercial |
$0.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$0.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$0.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$0.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.95
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
5101310201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,297.40 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna of VT Commercial |
$1,665.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,297.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,297.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,472.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,402.40
|
| Rate for Payer: Cash Price |
$876.50
|
| Rate for Payer: Cigna Commercial |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,402.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,402.40
|
| Rate for Payer: Multiplan Commercial |
$1,630.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,490.05
|
| Rate for Payer: United Healthcare Commercial |
$1,665.35
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$182.54 |
| Rate for Payer: Aetna of VT Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$0.93
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9601310202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$306.40 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna of VT Commercial |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$306.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$306.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$347.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$331.20
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$331.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$351.90
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$2,167.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9601310201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$2,036.98 |
| Rate for Payer: Aetna of VT Commercial |
$2,036.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,941.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,941.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$1,083.50
|
| Rate for Payer: Cash Price |
$1,083.50
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$2,015.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$2,167.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9601310201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$2,058.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,058.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,941.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$959.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,941.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,304.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,841.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,755.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$975.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,722.77
|
| Rate for Payer: Cash Price |
$1,083.50
|
| Rate for Payer: Cigna Commercial |
$1,733.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,733.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,733.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$975.15
|
| Rate for Payer: Multiplan Commercial |
$2,015.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,841.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$975.15
|
| Rate for Payer: United Healthcare Commercial |
$2,058.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$975.15
|
| Rate for Payer: United Healthcare VA CCN |
$975.15
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$2,167.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9601310201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,603.80 |
| Max. Negotiated Rate |
$2,058.65 |
| Rate for Payer: Aetna of VT Commercial |
$2,058.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,603.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,603.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,841.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,820.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,733.60
|
| Rate for Payer: Cash Price |
$1,083.50
|
| Rate for Payer: Cigna Commercial |
$1,733.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,733.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,733.60
|
| Rate for Payer: Multiplan Commercial |
$2,015.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,841.95
|
| Rate for Payer: United Healthcare Commercial |
$2,058.65
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
IP
|
$1,752.63
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
4501310201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,297.12 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,665.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,297.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,297.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,489.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,472.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,402.10
|
| Rate for Payer: Cash Price |
$876.32
|
| Rate for Payer: Cigna Commercial |
$1,402.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,402.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,402.10
|
| Rate for Payer: Multiplan Commercial |
$1,629.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,489.74
|
| Rate for Payer: United Healthcare Commercial |
$1,665.00
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
9811310202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.94 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna of VT Commercial |
$389.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$370.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.54
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$120.82
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$178.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$178.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$108.66
|
| Rate for Payer: Multiplan Commercial |
$385.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$93.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare Commercial |
$101.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.94
|
| Rate for Payer: United Healthcare VA CCN |
$65.94
|
|
|
CMPLX RPR TRUNK ADDL 5CM/<
|
Facility
|
OP
|
$1,752.63
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
4501310201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$776.24 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,665.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,570.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$776.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,570.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,055.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,489.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,419.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$788.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,393.34
|
| Rate for Payer: Cash Price |
$876.32
|
| Rate for Payer: Cigna Commercial |
$1,402.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,402.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,402.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$788.68
|
| Rate for Payer: Multiplan Commercial |
$1,629.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,489.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$788.68
|
| Rate for Payer: United Healthcare Commercial |
$1,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$788.68
|
| Rate for Payer: United Healthcare VA CCN |
$788.68
|
|
|
CMV ANTIBODY IGM
|
Facility
|
IP
|
$98.18
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
3008664501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.66 |
| Max. Negotiated Rate |
$93.27 |
| Rate for Payer: Aetna of VT Commercial |
$93.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$72.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$72.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.54
|
| Rate for Payer: Cash Price |
$49.09
|
| Rate for Payer: Cigna Commercial |
$78.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.54
|
| Rate for Payer: Multiplan Commercial |
$91.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.45
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
|
|
CMV ANTIBODY IGM
|
Professional
|
Both
|
$98.18
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
3008664501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$92.29 |
| Rate for Payer: Aetna of VT Commercial |
$92.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$17.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$23.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$19.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$28.80
|
| Rate for Payer: Cash Price |
$49.09
|
| Rate for Payer: Cash Price |
$49.09
|
| Rate for Payer: Cigna Commercial |
$20.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$16.85
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$16.85
|
| Rate for Payer: Martins Point Health Care Commercial |
$16.61
|
| Rate for Payer: Multiplan Commercial |
$91.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$25.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare VA CCN |
$16.85
|
|
|
CMV ANTIBODY IGM
|
Facility
|
OP
|
$98.18
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
3008664501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$93.27 |
| Rate for Payer: Aetna of VT Commercial |
$93.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$59.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$83.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$44.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.05
|
| Rate for Payer: Cash Price |
$49.09
|
| Rate for Payer: Cash Price |
$49.09
|
| Rate for Payer: Cigna Commercial |
$78.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$78.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$78.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$44.18
|
| Rate for Payer: Multiplan Commercial |
$91.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$83.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$44.18
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare VA CCN |
$44.18
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$162.62 |
| Rate for Payer: Aetna of VT Commercial |
$162.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare VA CCN |
$69.20
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$63.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$83.47
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare VA CCN |
$47.25
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
510S028501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$57.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.20
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$128.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$145.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.40
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of VT Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$77.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$84.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$84.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$89.25
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$98.70 |
| Rate for Payer: Aetna of VT Commercial |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$94.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$94.07
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$97.65
|
| Rate for Payer: United Healthcare Commercial |
$89.25
|
| Rate for Payer: United Healthcare VA CCN |
$42.00
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
960S028501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna of VT Commercial |
$164.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$154.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$147.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$137.53
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$138.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$138.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.85
|
| Rate for Payer: Multiplan Commercial |
$160.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.85
|
| Rate for Payer: United Healthcare VA CCN |
$77.85
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
510S028501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$64.86 |
| Rate for Payer: Aetna of VT Commercial |
$64.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: United Healthcare Commercial |
$58.65
|
| Rate for Payer: United Healthcare VA CCN |
$27.60
|
|
|
CNSLT BEFORE SCREEN COLONOSCOP
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT S0285
|
| Hospital Charge Code |
510S028501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of VT Commercial |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$30.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$61.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$41.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$55.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$54.85
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$55.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$55.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$64.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$58.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.05
|
| Rate for Payer: United Healthcare VA CCN |
$31.05
|
|
