|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
IP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
616C8914LT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$3,462.82 |
| 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 |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,930.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,743.08
|
| 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: Multiplan Commercial |
$4,351.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.02
|
| Rate for Payer: United Healthcare Commercial |
$4,444.91
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
IP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
616C891450
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$3,462.82 |
| 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 |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,930.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,743.08
|
| 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: Multiplan Commercial |
$4,351.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.02
|
| Rate for Payer: United Healthcare Commercial |
$4,444.91
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
IP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
616C8914RT
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$3,462.82 |
| 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 |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,462.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,930.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,743.08
|
| 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: Multiplan Commercial |
$4,351.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.02
|
| Rate for Payer: United Healthcare Commercial |
$4,444.91
|
|
|
MRA W/O FOL W/CONT, LWR EXT
|
Facility
|
OP
|
$4,678.85
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
616C891450
|
|
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
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 73725 26
|
| Hospital Charge Code |
972C891401
|
|
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
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 74182 26
|
| Hospital Charge Code |
9727418201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$110.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$223.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.75
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.50
|
| Rate for Payer: United Healthcare VA CCN |
$112.50
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$3,776.17
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
6107418201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,794.74 |
| Max. Negotiated Rate |
$3,587.36 |
| Rate for Payer: Aetna of VT Commercial |
$3,587.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,794.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,794.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,209.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,171.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,020.94
|
| Rate for Payer: Cash Price |
$1,888.09
|
| Rate for Payer: Cigna Commercial |
$3,020.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,020.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,020.94
|
| Rate for Payer: Multiplan Commercial |
$3,511.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,209.74
|
| Rate for Payer: United Healthcare Commercial |
$3,587.36
|
|
|
MRI ABDOMEN W/CONTRAST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 74182 26
|
| Hospital Charge Code |
9727418201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$997.83 |
| Rate for Payer: Aetna of VT Commercial |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$997.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$997.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$108.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$128.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$128.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$88.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$128.26
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$121.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$77.21
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$77.21
|
| Rate for Payer: United Healthcare Commercial |
$118.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.21
|
| Rate for Payer: United Healthcare VA CCN |
$77.21
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 74182 26
|
| Hospital Charge Code |
9727418201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$185.03 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna of VT Commercial |
$237.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$185.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$212.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$200.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$200.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.50
|
| Rate for Payer: United Healthcare Commercial |
$237.50
|
|
|
MRI ABDOMEN W/CONTRAST
|
Facility
|
OP
|
$3,776.17
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
6107418201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$997.83 |
| Max. Negotiated Rate |
$3,587.36 |
| Rate for Payer: Aetna of VT Commercial |
$3,587.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$997.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,672.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$997.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,273.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,209.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,058.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,699.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,002.06
|
| Rate for Payer: Cash Price |
$1,888.09
|
| Rate for Payer: Cash Price |
$1,888.09
|
| Rate for Payer: Cigna Commercial |
$3,020.94
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,020.94
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,020.94
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,699.28
|
| Rate for Payer: Multiplan Commercial |
$3,511.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,209.74
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,699.28
|
| Rate for Payer: United Healthcare Commercial |
$3,587.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,699.28
|
| Rate for Payer: United Healthcare VA CCN |
$1,699.28
|
|
|
MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$2,819.72
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
6107418101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$576.11 |
| Max. Negotiated Rate |
$2,678.73 |
| Rate for Payer: Aetna of VT Commercial |
$2,678.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$576.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,248.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$576.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,697.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,396.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,283.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,268.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,241.68
|
| Rate for Payer: Cash Price |
$1,409.86
|
| Rate for Payer: Cash Price |
$1,409.86
|
| Rate for Payer: Cigna Commercial |
$2,255.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,255.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,255.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,268.87
|
| Rate for Payer: Multiplan Commercial |
$2,622.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,396.76
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,268.87
|
| Rate for Payer: United Healthcare Commercial |
$2,678.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,268.87
|
| Rate for Payer: United Healthcare VA CCN |
$1,268.87
|
|
|
MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$2,819.72
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
6107418101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,086.87 |
| Max. Negotiated Rate |
$2,678.73 |
| Rate for Payer: Aetna of VT Commercial |
$2,678.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,086.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,086.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,396.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,368.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,255.78
|
| Rate for Payer: Cash Price |
$1,409.86
|
| Rate for Payer: Cigna Commercial |
$2,255.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,255.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,255.78
|
| Rate for Payer: Multiplan Commercial |
$2,622.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,396.76
|
| Rate for Payer: United Healthcare Commercial |
$2,678.73
|
|
|
MRI ABDOMEN W/O CONTRAST
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
CPT 74181 26
|
| Hospital Charge Code |
9727418101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of VT Commercial |
$198.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$576.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$67.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$576.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$91.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$104.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$74.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$104.80
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$102.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$65.10
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$65.10
|
| Rate for Payer: United Healthcare Commercial |
$100.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.10
|
| Rate for Payer: United Healthcare VA CCN |
$65.10
|
|
|
MRI ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 74181 26
|
| Hospital Charge Code |
9727418101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna of VT Commercial |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$93.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$127.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$167.75
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$94.95
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$94.95
|
| Rate for Payer: United Healthcare Commercial |
$200.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.95
|
| Rate for Payer: United Healthcare VA CCN |
$94.95
|
|
|
MRI ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 74181 26
|
| Hospital Charge Code |
9727418101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna of VT Commercial |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$156.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$179.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$177.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$168.80
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$168.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$196.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.35
|
| Rate for Payer: United Healthcare Commercial |
$200.45
|
|
|
MRI ABDOMEN W/O & W/CONTRAST
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 74183 26
|
| Hospital Charge Code |
9727418301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$139.51 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna of VT Commercial |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$282.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$139.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$282.21
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$189.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$250.43
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.75
|
| Rate for Payer: United Healthcare Commercial |
$299.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.75
|
| Rate for Payer: United Healthcare VA CCN |
$141.75
|
|
|
MRI ABDOMEN W/O & W/CONTRAST
|
Facility
|
OP
|
$4,238.37
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
6107418301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,061.41 |
| Max. Negotiated Rate |
$4,026.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,026.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,061.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,877.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,061.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,551.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,602.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,433.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,907.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,369.50
|
| Rate for Payer: Cash Price |
$2,119.18
|
| Rate for Payer: Cash Price |
$2,119.18
|
| Rate for Payer: Cigna Commercial |
$3,390.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,390.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,390.70
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,907.27
|
| Rate for Payer: Multiplan Commercial |
$3,941.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,602.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,907.27
|
| Rate for Payer: United Healthcare Commercial |
$4,026.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,907.27
|
| Rate for Payer: United Healthcare VA CCN |
$1,907.27
|
|
|
MRI ABDOMEN W/O & W/CONTRAST
|
Facility
|
IP
|
$4,238.37
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
6107418301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,136.82 |
| Max. Negotiated Rate |
$4,026.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,026.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,136.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,136.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,602.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,560.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,390.70
|
| Rate for Payer: Cash Price |
$2,119.18
|
| Rate for Payer: Cigna Commercial |
$3,390.70
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,390.70
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,390.70
|
| Rate for Payer: Multiplan Commercial |
$3,941.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,602.61
|
| Rate for Payer: United Healthcare Commercial |
$4,026.45
|
|
|
MRI ABDOMEN W/O & W/CONTRAST
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 74183 26
|
| Hospital Charge Code |
9727418301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$233.13 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna of VT Commercial |
$299.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$252.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$252.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$299.25
|
|
|
MRI ABDOMEN W/O & W/CONTRAST
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 74183 26
|
| Hospital Charge Code |
9727418301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$1,061.41 |
| Rate for Payer: Aetna of VT Commercial |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,061.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,061.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$137.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$162.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$113.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$162.29
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$154.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$292.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$151.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.55
|
| Rate for Payer: United Healthcare VA CCN |
$98.55
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
9727055201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$238.31 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna of VT Commercial |
$305.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$270.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$257.60
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.70
|
| Rate for Payer: United Healthcare Commercial |
$305.90
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
IP
|
$3,289.15
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
6117055201
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,434.30 |
| Max. Negotiated Rate |
$3,124.69 |
| Rate for Payer: Aetna of VT Commercial |
$3,124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,434.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,434.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,795.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,762.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,631.32
|
| Rate for Payer: Cash Price |
$1,644.58
|
| Rate for Payer: Cigna Commercial |
$2,631.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,631.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,631.32
|
| Rate for Payer: Multiplan Commercial |
$3,058.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,795.78
|
| Rate for Payer: United Healthcare Commercial |
$3,124.69
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
9727055201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$142.61 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna of VT Commercial |
$305.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$288.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$142.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$288.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$193.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$273.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$260.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$255.99
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$257.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$257.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$144.90
|
| Rate for Payer: Multiplan Commercial |
$299.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$273.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.90
|
| Rate for Payer: United Healthcare Commercial |
$305.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.90
|
| Rate for Payer: United Healthcare VA CCN |
$144.90
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
OP
|
$3,289.15
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
6117055201
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$843.22 |
| Max. Negotiated Rate |
$3,124.69 |
| Rate for Payer: Aetna of VT Commercial |
$3,124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$843.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,456.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$843.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,980.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,795.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,664.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,480.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,614.87
|
| Rate for Payer: Cash Price |
$1,644.58
|
| Rate for Payer: Cash Price |
$1,644.58
|
| Rate for Payer: Cigna Commercial |
$2,631.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,631.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,631.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,480.12
|
| Rate for Payer: Multiplan Commercial |
$3,058.91
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,795.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,480.12
|
| Rate for Payer: United Healthcare Commercial |
$3,124.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,480.12
|
| Rate for Payer: United Healthcare VA CCN |
$1,480.12
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
OP
|
$3,245.73
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
6117055101
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$573.25 |
| Max. Negotiated Rate |
$3,083.44 |
| Rate for Payer: Aetna of VT Commercial |
$3,083.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$573.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,437.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$573.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,953.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,758.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,629.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,460.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,580.36
|
| Rate for Payer: Cash Price |
$1,622.87
|
| Rate for Payer: Cash Price |
$1,622.87
|
| Rate for Payer: Cigna Commercial |
$2,596.58
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,596.58
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,596.58
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,460.58
|
| Rate for Payer: Multiplan Commercial |
$3,018.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,758.87
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,460.58
|
| Rate for Payer: United Healthcare Commercial |
$3,083.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,460.58
|
| Rate for Payer: United Healthcare VA CCN |
$1,460.58
|
|
