|
MRA NECK W/CONTRAST MATERIAL
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 70548 26
|
| Hospital Charge Code |
9727054801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$160.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$182.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$173.60
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
|
|
MRA NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 70548 26
|
| Hospital Charge Code |
9727054801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$67.04 |
| Max. Negotiated Rate |
$791.24 |
| Rate for Payer: Aetna of VT Commercial |
$203.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$791.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$93.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$97.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$77.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$97.38
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$105.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.04
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$67.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$67.04
|
| Rate for Payer: United Healthcare Commercial |
$103.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.04
|
| Rate for Payer: United Healthcare VA CCN |
$67.04
|
|
|
MRA NECK W/CONTRAST MATERIAL
|
Facility
|
OP
|
$4,601.92
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
6157054801
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$791.24 |
| 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 |
$791.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,038.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$791.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,770.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,911.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,727.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,070.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,658.53
|
| Rate for Payer: Cash Price |
$2,300.96
|
| 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: Martins Point Health Care Commercial |
$2,070.86
|
| Rate for Payer: Multiplan Commercial |
$4,279.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,911.63
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,070.86
|
| Rate for Payer: United Healthcare Commercial |
$4,371.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,070.86
|
| Rate for Payer: United Healthcare VA CCN |
$2,070.86
|
|
|
MRA NECK W/CONTRAST MATERIAL
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 70548 26
|
| Hospital Charge Code |
9727054801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna of VT Commercial |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$96.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$194.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$175.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$97.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.51
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$173.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$173.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$97.65
|
| Rate for Payer: Multiplan Commercial |
$201.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$184.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare Commercial |
$206.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.65
|
| Rate for Payer: United Healthcare VA CCN |
$97.65
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 70547 26
|
| Hospital Charge Code |
9727054701
|
|
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 NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 70547 26
|
| Hospital Charge Code |
9727054701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.79 |
| Max. Negotiated Rate |
$718.99 |
| Rate for Payer: Aetna of VT Commercial |
$203.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$718.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$55.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$718.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$75.31
|
| 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 |
$61.86
|
| 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 |
$53.79
|
| 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 |
$53.79
|
| Rate for Payer: United Healthcare Commercial |
$82.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.79
|
| Rate for Payer: United Healthcare VA CCN |
$53.79
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
IP
|
$3,431.85
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
6157054701
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,539.91 |
| Max. Negotiated Rate |
$3,260.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,260.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,539.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,917.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,745.48
|
| Rate for Payer: Cash Price |
$1,715.92
|
| Rate for Payer: Cigna Commercial |
$2,745.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,745.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,745.48
|
| Rate for Payer: Multiplan Commercial |
$3,191.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,917.07
|
| Rate for Payer: United Healthcare Commercial |
$3,260.26
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
OP
|
$3,431.85
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
6157054701
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$718.99 |
| Max. Negotiated Rate |
$3,260.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,260.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$718.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,519.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$718.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,065.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,917.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,779.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,544.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,728.32
|
| Rate for Payer: Cash Price |
$1,715.92
|
| Rate for Payer: Cash Price |
$1,715.92
|
| Rate for Payer: Cigna Commercial |
$2,745.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,745.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,745.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,544.33
|
| Rate for Payer: Multiplan Commercial |
$3,191.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,917.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,544.33
|
| Rate for Payer: United Healthcare Commercial |
$3,260.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,544.33
|
| Rate for Payer: United Healthcare VA CCN |
$1,544.33
|
|
|
MRA NECK W/O CONTRST MATERIAL
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 70547 26
|
| Hospital Charge Code |
9727054701
|
|
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 NECK W/O &W/CONTRAST
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 70549 26
|
| Hospital Charge Code |
9727054901
|
|
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 NECK W/O &W/CONTRAST
|
Facility
|
OP
|
$4,720.21
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
6157054901
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,175.35 |
| Max. Negotiated Rate |
$4,484.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,484.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,175.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,090.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,175.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,012.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,823.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,124.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,360.10
|
| Rate for Payer: Cash Price |
$2,360.10
|
| Rate for Payer: Cigna Commercial |
$3,776.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,776.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,776.17
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,124.09
|
| Rate for Payer: Multiplan Commercial |
$4,389.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,012.18
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,124.09
|
| Rate for Payer: United Healthcare Commercial |
$4,484.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,124.09
|
| Rate for Payer: United Healthcare VA CCN |
$2,124.09
|
|
|
MRA NECK W/O &W/CONTRAST
|
Facility
|
IP
|
$4,720.21
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
6157054901
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,493.43 |
| Max. Negotiated Rate |
$4,484.20 |
| Rate for Payer: Aetna of VT Commercial |
$4,484.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,493.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,493.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,012.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,964.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,776.17
|
| Rate for Payer: Cash Price |
$2,360.10
|
| Rate for Payer: Cigna Commercial |
$3,776.17
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,776.17
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,776.17
|
| Rate for Payer: Multiplan Commercial |
$4,389.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,012.18
|
| Rate for Payer: United Healthcare Commercial |
$4,484.20
|
|
|
MRA NECK W/O &W/CONTRAST
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 70549 26
|
| Hospital Charge Code |
9727054901
|
|
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/O &W/CONTRAST
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 70549 26
|
| Hospital Charge Code |
9727054901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.44 |
| Max. Negotiated Rate |
$1,175.35 |
| Rate for Payer: Aetna of VT Commercial |
$303.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,175.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,175.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.62
|
| 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 |
$92.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.17
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$126.24
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.45
|
| Rate for Payer: Multiplan Commercial |
$300.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.44
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.44
|
| Rate for Payer: United Healthcare Commercial |
$123.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.44
|
| Rate for Payer: United Healthcare VA CCN |
$80.44
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
OP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
616C891350
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,132.00 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,548.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,104.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,832.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,573.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,779.69
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,573.41
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare VA CCN |
$1,573.41
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
OP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
616C8913RT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,132.00 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,548.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,104.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,832.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,573.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,779.69
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,573.41
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare VA CCN |
$1,573.41
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
OP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
616C8913LT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,132.00 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,548.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,104.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,832.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,573.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,779.69
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,573.41
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,573.41
|
| Rate for Payer: United Healthcare VA CCN |
$1,573.41
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
IP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
616C8913LT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,587.74 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,937.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,797.18
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
IP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
616C8913RT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,587.74 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,937.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,797.18
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
IP
|
$3,496.47
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
616C891350
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,587.74 |
| Max. Negotiated Rate |
$3,321.65 |
| Rate for Payer: Aetna of VT Commercial |
$3,321.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,587.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,937.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,797.18
|
| Rate for Payer: Cash Price |
$1,748.23
|
| Rate for Payer: Cigna Commercial |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,797.18
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,797.18
|
| Rate for Payer: Multiplan Commercial |
$3,251.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,972.00
|
| Rate for Payer: United Healthcare Commercial |
$3,321.65
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
972C891301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$209.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.91
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.55
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.55
|
| Rate for Payer: United Healthcare VA CCN |
$116.55
|
|
|
MRA W/O CONT, LWR EXT
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
972C891301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
OP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
616C8914RT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,132.00 |
| Max. Negotiated Rate |
$4,444.91 |
| Rate for Payer: Aetna of VT Commercial |
$4,444.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,072.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,816.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,789.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,105.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,719.69
|
| Rate for Payer: Cash Price |
$2,339.43
|
| Rate for Payer: Cash Price |
$2,339.43
|
| Rate for Payer: Cigna Commercial |
$3,743.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,743.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,743.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,105.48
|
| Rate for Payer: Multiplan Commercial |
$4,351.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,105.48
|
| Rate for Payer: United Healthcare Commercial |
$4,444.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,105.48
|
| Rate for Payer: United Healthcare VA CCN |
$2,105.48
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 73725 26
|
| Hospital Charge Code |
972C891401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna of VT Commercial |
$246.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$220.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$217.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$207.20
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$207.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$240.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.15
|
| Rate for Payer: United Healthcare Commercial |
$246.05
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
OP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
616C8914LT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,132.00 |
| Max. Negotiated Rate |
$4,444.91 |
| Rate for Payer: Aetna of VT Commercial |
$4,444.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,072.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,816.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,789.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,105.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,719.69
|
| Rate for Payer: Cash Price |
$2,339.43
|
| Rate for Payer: Cash Price |
$2,339.43
|
| Rate for Payer: Cigna Commercial |
$3,743.08
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,743.08
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,743.08
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,105.48
|
| Rate for Payer: Multiplan Commercial |
$4,351.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,105.48
|
| Rate for Payer: United Healthcare Commercial |
$4,444.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,105.48
|
| Rate for Payer: United Healthcare VA CCN |
$2,105.48
|
|
