|
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
Professional
|
Both
|
$1,016.34
|
|
|
Service Code
|
CPT 88377
|
| Hospital Charge Code |
3008837701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$1,615.09 |
| Rate for Payer: Aetna of VT Commercial |
$955.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,615.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$384.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,615.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$522.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$516.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$516.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$429.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$516.79
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cash Price |
$508.17
|
| Rate for Payer: Cigna Commercial |
$509.24
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$598.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$598.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$373.26
|
| Rate for Payer: Multiplan Commercial |
$945.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$373.26
|
| Rate for Payer: United Healthcare Commercial |
$574.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.26
|
| Rate for Payer: United Healthcare VA CCN |
$373.26
|
|
|
MPL GENE SEQ ALYS EXON 10
|
Facility
|
OP
|
$463.09
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
3008133901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$912.57 |
| Rate for Payer: Aetna of VT Commercial |
$439.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$912.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$205.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$912.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$278.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$208.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$368.16
|
| Rate for Payer: Cash Price |
$231.54
|
| Rate for Payer: Cash Price |
$231.54
|
| Rate for Payer: Cigna Commercial |
$370.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$208.39
|
| Rate for Payer: Multiplan Commercial |
$430.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$393.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$208.39
|
| Rate for Payer: United Healthcare Commercial |
$439.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.20
|
| Rate for Payer: United Healthcare VA CCN |
$208.39
|
|
|
MPL GENE SEQ ALYS EXON 10
|
Professional
|
Both
|
$463.09
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
3008133901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$912.57 |
| Rate for Payer: Aetna of VT Commercial |
$435.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$912.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$190.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$912.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$259.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$218.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$218.31
|
| Rate for Payer: Cash Price |
$231.54
|
| Rate for Payer: Cash Price |
$231.54
|
| Rate for Payer: Cigna Commercial |
$224.51
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$185.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$185.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$182.61
|
| Rate for Payer: Multiplan Commercial |
$430.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$185.20
|
| Rate for Payer: United Healthcare Commercial |
$284.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.20
|
| Rate for Payer: United Healthcare VA CCN |
$185.20
|
|
|
MPL GENE SEQ ALYS EXON 10
|
Facility
|
IP
|
$463.09
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
3008133901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$342.73 |
| Max. Negotiated Rate |
$439.94 |
| Rate for Payer: Aetna of VT Commercial |
$439.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$342.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$342.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$389.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$370.47
|
| Rate for Payer: Cash Price |
$231.54
|
| Rate for Payer: Cigna Commercial |
$370.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$370.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$370.47
|
| Rate for Payer: Multiplan Commercial |
$430.67
|
| Rate for Payer: MVP Health Care of NY Commercial |
$393.63
|
| Rate for Payer: United Healthcare Commercial |
$439.94
|
|
|
MRA ABDOMEN W/WO CONTRAST
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
CPT 74185 26
|
| Hospital Charge Code |
9727418501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$79.81 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Aetna of VT Commercial |
$241.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$111.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$133.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$91.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.17
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$125.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.81
|
| Rate for Payer: Multiplan Commercial |
$239.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.81
|
| Rate for Payer: United Healthcare Commercial |
$122.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.81
|
| Rate for Payer: United Healthcare VA CCN |
$79.81
|
|
|
MRA ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 74185 26
|
| Hospital Charge Code |
9727418501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$190.21 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Aetna of VT Commercial |
$244.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$190.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$218.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.60
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$205.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.60
|
| Rate for Payer: Multiplan Commercial |
$239.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$218.45
|
| Rate for Payer: United Healthcare Commercial |
$244.15
|
|
|
MRA ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$1,637.08
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
6187418501
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$725.06 |
| Max. Negotiated Rate |
$1,555.23 |
| Rate for Payer: Aetna of VT Commercial |
$1,555.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$725.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,139.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$985.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,391.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,326.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$736.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,301.48
|
| Rate for Payer: Cash Price |
$818.54
|
| Rate for Payer: Cash Price |
$818.54
|
| Rate for Payer: Cigna Commercial |
$1,309.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,309.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,309.66
|
| Rate for Payer: Martins Point Health Care Commercial |
$736.69
|
| Rate for Payer: Multiplan Commercial |
$1,522.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,391.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$736.69
|
| Rate for Payer: United Healthcare Commercial |
$1,555.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$736.69
|
| Rate for Payer: United Healthcare VA CCN |
$736.69
|
|
|
MRA ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 74185 26
|
| Hospital Charge Code |
9727418501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$244.15 |
| Rate for Payer: Aetna of VT Commercial |
$244.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$230.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$230.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$218.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.31
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$205.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$205.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$205.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.65
|
| Rate for Payer: Multiplan Commercial |
$239.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$218.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.65
|
| Rate for Payer: United Healthcare Commercial |
$244.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.65
|
| Rate for Payer: United Healthcare VA CCN |
$115.65
|
|
|
MRA ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$1,637.08
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
6187418501
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,211.60 |
| Max. Negotiated Rate |
$1,555.23 |
| Rate for Payer: Aetna of VT Commercial |
$1,555.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,211.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,211.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,391.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,375.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,309.66
|
| Rate for Payer: Cash Price |
$818.54
|
| Rate for Payer: Cigna Commercial |
$1,309.66
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,309.66
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,309.66
|
| Rate for Payer: Multiplan Commercial |
$1,522.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,391.52
|
| Rate for Payer: United Healthcare Commercial |
$1,555.23
|
|
|
MRA HEAD W/CONTRAST MATERIAL
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 70545 26
|
| Hospital Charge Code |
9727054501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$95.67 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of VT Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.20
|
| Rate for Payer: United Healthcare Commercial |
$205.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.20
|
| Rate for Payer: United Healthcare VA CCN |
$97.20
|
|
|
MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 70545 26
|
| Hospital Charge Code |
9727054501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$769.56 |
| Rate for Payer: Aetna of VT Commercial |
$203.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$769.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$769.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$85.93
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$84.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.46
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.47
|
| Rate for Payer: United Healthcare Commercial |
$82.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.47
|
| Rate for Payer: United Healthcare VA CCN |
$53.47
|
|
|
MRA HEAD W/CONTRAST MATERIAL
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 70545 26
|
| Hospital Charge Code |
9727054501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$159.86 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of VT Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.60
|
| Rate for Payer: United Healthcare Commercial |
$205.20
|
|
|
MRA HEAD W/CONTRAST MATERIAL
|
Facility
|
IP
|
$5,014.80
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
6157054501
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,711.45 |
| Max. Negotiated Rate |
$4,764.06 |
| Rate for Payer: Aetna of VT Commercial |
$4,764.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,711.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,711.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,262.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,212.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,011.84
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cigna Commercial |
$4,011.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,011.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,011.84
|
| Rate for Payer: Multiplan Commercial |
$4,663.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,262.58
|
| Rate for Payer: United Healthcare Commercial |
$4,764.06
|
|
|
MRA HEAD W/CONTRAST MATERIAL
|
Facility
|
OP
|
$5,014.80
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
6157054501
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$769.56 |
| Max. Negotiated Rate |
$4,764.06 |
| Rate for Payer: Aetna of VT Commercial |
$4,764.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$769.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,221.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$769.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,018.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,262.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,061.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,256.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,986.77
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cigna Commercial |
$4,011.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,011.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,011.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,256.66
|
| Rate for Payer: Multiplan Commercial |
$4,663.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,262.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,256.66
|
| Rate for Payer: United Healthcare Commercial |
$4,764.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,256.66
|
| Rate for Payer: United Healthcare VA CCN |
$2,256.66
|
|
|
MRA HEAD W/O CONTRST MATERIAL
|
Facility
|
IP
|
$3,399.53
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
6157054401
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,515.99 |
| Max. Negotiated Rate |
$3,229.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,515.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,515.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,889.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,855.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,719.62
|
| Rate for Payer: Cash Price |
$1,699.77
|
| Rate for Payer: Cigna Commercial |
$2,719.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,719.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,719.62
|
| Rate for Payer: Multiplan Commercial |
$3,161.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,889.60
|
| Rate for Payer: United Healthcare Commercial |
$3,229.55
|
|
|
MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 70544 26
|
| Hospital Charge Code |
9727054401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$717.54 |
| Rate for Payer: Aetna of VT Commercial |
$203.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$717.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$717.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$61.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.05
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$84.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$53.46
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$53.47
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$53.47
|
| Rate for Payer: United Healthcare Commercial |
$82.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.47
|
| Rate for Payer: United Healthcare VA CCN |
$53.47
|
|
|
MRA HEAD W/O CONTRST MATERIAL
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 70544 26
|
| Hospital Charge Code |
9727054401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$95.67 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of VT Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$193.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$171.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.20
|
| Rate for Payer: United Healthcare Commercial |
$205.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.20
|
| Rate for Payer: United Healthcare VA CCN |
$97.20
|
|
|
MRA HEAD W/O CONTRST MATERIAL
|
Facility
|
OP
|
$3,399.53
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
6157054401
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$717.54 |
| Max. Negotiated Rate |
$3,229.55 |
| Rate for Payer: Aetna of VT Commercial |
$3,229.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$717.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,505.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$717.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,046.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,889.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,753.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,529.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,702.63
|
| Rate for Payer: Cash Price |
$1,699.77
|
| Rate for Payer: Cash Price |
$1,699.77
|
| Rate for Payer: Cigna Commercial |
$2,719.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,719.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,719.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,529.79
|
| Rate for Payer: Multiplan Commercial |
$3,161.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,889.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,529.79
|
| Rate for Payer: United Healthcare Commercial |
$3,229.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,529.79
|
| Rate for Payer: United Healthcare VA CCN |
$1,529.79
|
|
|
MRA HEAD W/O CONTRST MATERIAL
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 70544 26
|
| Hospital Charge Code |
9727054401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$159.86 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna of VT Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$200.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$183.60
|
| Rate for Payer: United Healthcare Commercial |
$205.20
|
|
|
MRA HEAD W/O & W/CONTRAST
|
Facility
|
IP
|
$3,312.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
6157054601
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,451.91 |
| Max. Negotiated Rate |
$3,147.29 |
| Rate for Payer: Aetna of VT Commercial |
$3,147.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,451.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,451.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,816.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,782.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,650.35
|
| Rate for Payer: Cash Price |
$1,656.47
|
| Rate for Payer: Cigna Commercial |
$2,650.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,650.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,650.35
|
| Rate for Payer: Multiplan Commercial |
$3,081.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,816.00
|
| Rate for Payer: United Healthcare Commercial |
$3,147.29
|
|
|
MRA HEAD W/O & W/CONTRAST
|
Facility
|
OP
|
$3,312.94
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
6157054601
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,169.59 |
| Max. Negotiated Rate |
$3,147.29 |
| Rate for Payer: Aetna of VT Commercial |
$3,147.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,169.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,467.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,169.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,994.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,816.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,683.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,490.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,633.79
|
| Rate for Payer: Cash Price |
$1,656.47
|
| Rate for Payer: Cash Price |
$1,656.47
|
| Rate for Payer: Cigna Commercial |
$2,650.35
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,650.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,650.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,490.82
|
| Rate for Payer: Multiplan Commercial |
$3,081.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,816.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,490.82
|
| Rate for Payer: United Healthcare Commercial |
$3,147.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,490.82
|
| Rate for Payer: United Healthcare VA CCN |
$1,490.82
|
|
|
MRA HEAD W/O & W/CONTRAST
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 70546 26
|
| Hospital Charge Code |
9727054601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$1,169.59 |
| Rate for Payer: Aetna of VT Commercial |
$303.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,169.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,169.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$129.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$129.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$75.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$129.30
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$104.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.07
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$66.07
|
| Rate for Payer: United Healthcare Commercial |
$101.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.07
|
| Rate for Payer: United Healthcare VA CCN |
$66.07
|
|
|
MRA HEAD W/O & W/CONTRAST
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 70546 26
|
| Hospital Charge Code |
9727054601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$239.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$271.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$258.40
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
|
|
MRA HEAD W/O & W/CONTRAST
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 70546 26
|
| Hospital Charge Code |
9727054601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna of VT Commercial |
$306.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$143.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$289.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$194.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$274.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$261.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$256.79
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$258.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$258.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$145.35
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare Commercial |
$306.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.35
|
| Rate for Payer: United Healthcare VA CCN |
$145.35
|
|
|
MRA NECK W/CONTRAST MATERIAL
|
Facility
|
IP
|
$4,601.92
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
6157054801
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,405.88 |
| Max. Negotiated Rate |
$4,371.82 |
| Rate for Payer: Aetna of VT Commercial |
$4,371.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,911.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,865.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,681.54
|
| Rate for Payer: Cash Price |
$2,300.96
|
| Rate for Payer: Cigna Commercial |
$3,681.54
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,681.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,681.54
|
| Rate for Payer: Multiplan Commercial |
$4,279.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,911.63
|
| Rate for Payer: United Healthcare Commercial |
$4,371.82
|
|
