|
MRI BRAIN STEM W/O DYE
|
Facility
|
IP
|
$3,245.73
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
6117055101
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,402.16 |
| 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 |
$2,402.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,402.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,758.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,726.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,596.58
|
| 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: Multiplan Commercial |
$3,018.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,758.87
|
| Rate for Payer: United Healthcare Commercial |
$3,083.44
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 70551 26
|
| Hospital Charge Code |
9727055101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$196.87 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Aetna of VT Commercial |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$196.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$196.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$212.80
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$212.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$212.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$212.80
|
| Rate for Payer: Multiplan Commercial |
$247.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.10
|
| Rate for Payer: United Healthcare Commercial |
$252.70
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 70551 26
|
| Hospital Charge Code |
9727055101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Aetna of VT Commercial |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$238.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$160.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$226.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$215.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$211.47
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$212.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$212.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$212.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$119.70
|
| Rate for Payer: Multiplan Commercial |
$247.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$226.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$252.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.70
|
| Rate for Payer: United Healthcare VA CCN |
$119.70
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
IP
|
$4,472.05
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
6107055301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,309.76 |
| Max. Negotiated Rate |
$4,248.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,248.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,309.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,309.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,801.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,756.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,577.64
|
| Rate for Payer: Cash Price |
$2,236.02
|
| Rate for Payer: Cigna Commercial |
$3,577.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,577.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,577.64
|
| Rate for Payer: Multiplan Commercial |
$4,159.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,801.24
|
| Rate for Payer: United Healthcare Commercial |
$4,248.45
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 70553 26
|
| Hospital Charge Code |
9727055301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$313.06 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna of VT Commercial |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$313.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$313.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$338.40
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.40
|
| Rate for Payer: Multiplan Commercial |
$393.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.55
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
OP
|
$4,472.05
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
6107055301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$954.47 |
| Max. Negotiated Rate |
$4,248.45 |
| Rate for Payer: Aetna of VT Commercial |
$4,248.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$954.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,980.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$954.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,692.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,801.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,622.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,012.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,555.28
|
| Rate for Payer: Cash Price |
$2,236.02
|
| Rate for Payer: Cash Price |
$2,236.02
|
| Rate for Payer: Cigna Commercial |
$3,577.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,577.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,577.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,012.42
|
| Rate for Payer: Multiplan Commercial |
$4,159.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,801.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,012.42
|
| Rate for Payer: United Healthcare Commercial |
$4,248.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,012.42
|
| Rate for Payer: United Healthcare VA CCN |
$2,012.42
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 70553 26
|
| Hospital Charge Code |
9727055301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$187.35 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna of VT Commercial |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.29
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$190.35
|
| Rate for Payer: Multiplan Commercial |
$393.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.35
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.35
|
| Rate for Payer: United Healthcare VA CCN |
$190.35
|
|
|
MRI BRAIN W/CONTRAST
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 70558 26
|
| Hospital Charge Code |
9727055801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$158.38 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna of VT Commercial |
$464.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$163.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$221.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$251.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$251.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$182.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$251.78
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$239.82
|
| Rate for Payer: Martins Point Health Care Commercial |
$158.38
|
| Rate for Payer: Multiplan Commercial |
$459.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.38
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$158.38
|
| Rate for Payer: United Healthcare Commercial |
$243.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.38
|
| Rate for Payer: United Healthcare VA CCN |
$158.38
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
OP
|
$2,144.11
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
6117055801
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$772.80 |
| Max. Negotiated Rate |
$2,036.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,036.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$949.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,290.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,822.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,736.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$964.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,704.57
|
| Rate for Payer: Cash Price |
$1,072.06
|
| Rate for Payer: Cash Price |
$1,072.06
|
| Rate for Payer: Cigna Commercial |
$1,715.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,715.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,715.29
|
| Rate for Payer: Martins Point Health Care Commercial |
$964.85
|
| Rate for Payer: Multiplan Commercial |
$1,994.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,822.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$964.85
|
| Rate for Payer: United Healthcare Commercial |
$2,036.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$964.85
|
| Rate for Payer: United Healthcare VA CCN |
$964.85
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
IP
|
$2,144.11
|
|
|
Service Code
|
CPT 70558
|
| Hospital Charge Code |
6117055801
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,586.86 |
| Max. Negotiated Rate |
$2,036.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,036.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,586.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,586.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,822.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,801.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,715.29
|
| Rate for Payer: Cash Price |
$1,072.06
|
| Rate for Payer: Cigna Commercial |
$1,715.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,715.29
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,715.29
|
| Rate for Payer: Multiplan Commercial |
$1,994.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,822.49
|
| Rate for Payer: United Healthcare Commercial |
$2,036.90
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 70558 26
|
| Hospital Charge Code |
9727055801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$365.61 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna of VT Commercial |
$469.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$365.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$365.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$414.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$395.20
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$395.20
|
| Rate for Payer: Multiplan Commercial |
$459.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.90
|
| Rate for Payer: United Healthcare Commercial |
$469.30
|
|
|
MRI BRAIN W/CONTRAST
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 70558 26
|
| Hospital Charge Code |
9727055801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$218.79 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna of VT Commercial |
$469.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$442.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$218.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$442.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$297.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$400.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$392.73
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$395.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$459.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$419.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$222.30
|
| Rate for Payer: United Healthcare Commercial |
$469.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.30
|
| Rate for Payer: United Healthcare VA CCN |
$222.30
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 70557 26
|
| Hospital Charge Code |
9727055701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$343.41 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Aetna of VT Commercial |
$440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$389.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$371.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna Commercial |
$371.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$371.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$371.20
|
| Rate for Payer: Multiplan Commercial |
$431.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.40
|
| Rate for Payer: United Healthcare Commercial |
$440.80
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 70557 26
|
| Hospital Charge Code |
9727055701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$205.51 |
| Max. Negotiated Rate |
$440.80 |
| Rate for Payer: Aetna of VT Commercial |
$440.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$415.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$205.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$415.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$279.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$394.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$375.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$368.88
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna Commercial |
$371.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$371.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$371.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$431.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$394.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$440.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$208.80
|
| Rate for Payer: United Healthcare VA CCN |
$208.80
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
IP
|
$2,327.53
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
6117055701
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,722.60 |
| Max. Negotiated Rate |
$2,211.15 |
| Rate for Payer: Aetna of VT Commercial |
$2,211.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,722.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,722.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,978.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,955.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,862.02
|
| Rate for Payer: Cash Price |
$1,163.77
|
| Rate for Payer: Cigna Commercial |
$1,862.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,862.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,862.02
|
| Rate for Payer: Multiplan Commercial |
$2,164.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,978.40
|
| Rate for Payer: United Healthcare Commercial |
$2,211.15
|
|
|
MRI BRAIN W/O CONTRAST
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
CPT 70557 26
|
| Hospital Charge Code |
9727055701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$2,318.83 |
| Rate for Payer: Aetna of VT Commercial |
$436.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,318.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$147.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,318.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$200.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$228.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$228.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$164.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$228.99
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cigna Commercial |
$217.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$143.20
|
| Rate for Payer: Multiplan Commercial |
$431.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$143.20
|
| Rate for Payer: United Healthcare Commercial |
$220.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.20
|
| Rate for Payer: United Healthcare VA CCN |
$143.20
|
|
|
MRI BRAIN W/O CONTRAST
|
Facility
|
OP
|
$2,327.53
|
|
|
Service Code
|
CPT 70557
|
| Hospital Charge Code |
6117055701
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,030.86 |
| Max. Negotiated Rate |
$2,318.83 |
| Rate for Payer: Aetna of VT Commercial |
$2,211.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,318.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,030.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,318.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,401.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,978.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,885.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,047.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,850.39
|
| Rate for Payer: Cash Price |
$1,163.77
|
| Rate for Payer: Cash Price |
$1,163.77
|
| Rate for Payer: Cigna Commercial |
$1,862.02
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,862.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,862.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,047.39
|
| Rate for Payer: Multiplan Commercial |
$2,164.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,978.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,047.39
|
| Rate for Payer: United Healthcare Commercial |
$2,211.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,047.39
|
| Rate for Payer: United Healthcare VA CCN |
$1,047.39
|
|
|
MRI BRAIN W/O & W/CONTRAST
|
Facility
|
OP
|
$6,253.63
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
6117055901
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$772.80 |
| Max. Negotiated Rate |
$5,940.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,940.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,769.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,764.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,315.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,065.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,814.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,971.64
|
| Rate for Payer: Cash Price |
$3,126.82
|
| Rate for Payer: Cash Price |
$3,126.82
|
| Rate for Payer: Cigna Commercial |
$5,002.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,002.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,002.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,814.13
|
| Rate for Payer: Multiplan Commercial |
$5,815.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,315.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,814.13
|
| Rate for Payer: United Healthcare Commercial |
$5,940.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,814.13
|
| Rate for Payer: United Healthcare VA CCN |
$2,814.13
|
|
|
MRI BRAIN W/O & W/CONTRAST
|
Facility
|
IP
|
$6,253.63
|
|
|
Service Code
|
CPT 70559
|
| Hospital Charge Code |
6117055901
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$4,628.31 |
| Max. Negotiated Rate |
$5,940.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,940.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,628.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,628.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,315.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,253.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,002.90
|
| Rate for Payer: Cash Price |
$3,126.82
|
| Rate for Payer: Cigna Commercial |
$5,002.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,002.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,002.90
|
| Rate for Payer: Multiplan Commercial |
$5,815.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,315.59
|
| Rate for Payer: United Healthcare Commercial |
$5,940.95
|
|
|
MRI BRAIN W/O & W/CONTRAST
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 70559 26
|
| Hospital Charge Code |
9727055901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna of VT Commercial |
$449.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$350.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$350.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$397.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$378.40
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.40
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.05
|
| Rate for Payer: United Healthcare Commercial |
$449.35
|
|
|
MRI BRAIN W/O & W/CONTRAST
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
CPT 70559 26
|
| Hospital Charge Code |
9727055901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$148.03 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna of VT Commercial |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$152.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$207.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$246.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$246.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$170.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.40
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$222.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.03
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.03
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.03
|
| Rate for Payer: United Healthcare Commercial |
$227.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.03
|
| Rate for Payer: United Healthcare VA CCN |
$148.03
|
|
|
MRI BRAIN W/O & W/CONTRAST
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 70559 26
|
| Hospital Charge Code |
9727055901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$209.49 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Aetna of VT Commercial |
$449.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$209.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$423.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$284.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$402.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$383.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$212.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$376.04
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$378.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$378.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$212.85
|
| Rate for Payer: Multiplan Commercial |
$439.89
|
| Rate for Payer: MVP Health Care of NY Commercial |
$402.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare Commercial |
$449.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.85
|
| Rate for Payer: United Healthcare VA CCN |
$212.85
|
|
|
MRI CANAL CERVICAL SPINE W/DYE
|
Facility
|
OP
|
$3,967.46
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
6127214201
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$863.44 |
| Max. Negotiated Rate |
$3,769.09 |
| Rate for Payer: Aetna of VT Commercial |
$3,769.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$863.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,757.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$863.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,388.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,372.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,213.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,785.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,154.13
|
| Rate for Payer: Cash Price |
$1,983.73
|
| Rate for Payer: Cash Price |
$1,983.73
|
| Rate for Payer: Cigna Commercial |
$3,173.97
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,173.97
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,173.97
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,785.36
|
| Rate for Payer: Multiplan Commercial |
$3,689.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,372.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,785.36
|
| Rate for Payer: United Healthcare Commercial |
$3,769.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,785.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,785.36
|
|
|
MRI CANAL CERVICAL SPINE W/DYE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 72142 26
|
| Hospital Charge Code |
9727214201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$114.27 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna of VT Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$114.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$231.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$155.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$205.11
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$206.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$206.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$116.10
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.10
|
| Rate for Payer: United Healthcare VA CCN |
$116.10
|
|
|
MRI CANAL CERVICAL SPINE W/DYE
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 72142 26
|
| Hospital Charge Code |
9727214201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.45 |
| Max. Negotiated Rate |
$863.44 |
| Rate for Payer: Aetna of VT Commercial |
$242.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$863.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$82.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$863.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$112.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$92.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$138.60
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$125.99
|
| Rate for Payer: Martins Point Health Care Commercial |
$80.45
|
| Rate for Payer: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$80.45
|
| Rate for Payer: United Healthcare Commercial |
$123.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.45
|
| Rate for Payer: United Healthcare VA CCN |
$80.45
|
|
