|
MRI CANAL CERVICAL SPINE W/DYE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 72142 26
|
| Hospital Charge Code |
9727214201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$190.95 |
| 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 |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$190.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$216.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.40
|
| 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: Multiplan Commercial |
$239.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.30
|
| Rate for Payer: United Healthcare Commercial |
$245.10
|
|
|
MRI CANAL CERVICAL SPINE W/DYE
|
Facility
|
IP
|
$3,967.46
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
6127214201
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,936.32 |
| 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 |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,372.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,332.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,173.97
|
| 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: Multiplan Commercial |
$3,689.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,372.34
|
| Rate for Payer: United Healthcare Commercial |
$3,769.09
|
|
|
MRI CAN CERVICAL SPINE W/O DYE
|
Facility
|
IP
|
$3,193.48
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
6127214101
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,363.49 |
| Max. Negotiated Rate |
$3,033.81 |
| Rate for Payer: Aetna of VT Commercial |
$3,033.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,363.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,363.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,714.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,682.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,554.78
|
| Rate for Payer: Cash Price |
$1,596.74
|
| Rate for Payer: Cigna Commercial |
$2,554.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,554.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,554.78
|
| Rate for Payer: Multiplan Commercial |
$2,969.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,714.46
|
| Rate for Payer: United Healthcare Commercial |
$3,033.81
|
|
|
MRI CAN CERVICAL SPINE W/O DYE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 72141 26
|
| Hospital Charge Code |
9727214101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$129.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$174.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.93
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.75
|
| Rate for Payer: United Healthcare VA CCN |
$96.75
|
|
|
MRI CAN CERVICAL SPINE W/O DYE
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 72141 26
|
| Hospital Charge Code |
9727214101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.39 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of VT Commercial |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$548.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$68.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$548.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$92.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$115.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$115.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$76.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$115.19
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$104.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$66.39
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$600.00
|
| Rate for Payer: United Healthcare Commercial |
$102.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.39
|
| Rate for Payer: United Healthcare VA CCN |
$66.39
|
|
|
MRI CAN CERVICAL SPINE W/O DYE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 72141 26
|
| Hospital Charge Code |
9727214101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna of VT Commercial |
$204.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$159.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$182.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$172.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$172.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$172.00
|
| Rate for Payer: Multiplan Commercial |
$199.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$182.75
|
| Rate for Payer: United Healthcare Commercial |
$204.25
|
|
|
MRI CAN CERVICAL SPINE W/O DYE
|
Facility
|
OP
|
$3,193.48
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
6127214101
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$548.67 |
| Max. Negotiated Rate |
$3,033.81 |
| Rate for Payer: Aetna of VT Commercial |
$3,033.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$548.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,414.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$548.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,922.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,714.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,586.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,437.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,538.82
|
| Rate for Payer: Cash Price |
$1,596.74
|
| Rate for Payer: Cash Price |
$1,596.74
|
| Rate for Payer: Cigna Commercial |
$2,554.78
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,554.78
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,554.78
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,437.07
|
| Rate for Payer: Multiplan Commercial |
$2,969.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,714.46
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,437.07
|
| Rate for Payer: United Healthcare Commercial |
$3,033.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,437.07
|
| Rate for Payer: United Healthcare VA CCN |
$1,437.07
|
|
|
MRI CHEST W/O DYE
|
Facility
|
OP
|
$2,933.07
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
6107155001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,029.62 |
| Max. Negotiated Rate |
$2,786.42 |
| Rate for Payer: Aetna of VT Commercial |
$2,786.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,029.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,299.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,029.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,765.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,493.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,375.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,319.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,331.79
|
| Rate for Payer: Cash Price |
$1,466.54
|
| Rate for Payer: Cash Price |
$1,466.54
|
| Rate for Payer: Cigna Commercial |
$2,346.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,346.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,346.46
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,319.88
|
| Rate for Payer: Multiplan Commercial |
$2,727.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,493.11
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,319.88
|
| Rate for Payer: United Healthcare Commercial |
$2,786.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,319.88
|
| Rate for Payer: United Healthcare VA CCN |
$1,319.88
|
|
|
MRI CHEST W/O DYE
|
Facility
|
IP
|
$2,933.07
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
6107155001
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,170.77 |
| Max. Negotiated Rate |
$2,786.42 |
| Rate for Payer: Aetna of VT Commercial |
$2,786.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,170.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,170.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,493.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,463.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,346.46
|
| Rate for Payer: Cash Price |
$1,466.54
|
| Rate for Payer: Cigna Commercial |
$2,346.46
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,346.46
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,346.46
|
| Rate for Payer: Multiplan Commercial |
$2,727.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,493.11
|
| Rate for Payer: United Healthcare Commercial |
$2,786.42
|
|
|
MRI CHEST W/O DYE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 71550 26
|
| Hospital Charge Code |
9727155001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna of VT Commercial |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.70
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$247.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.00
|
| Rate for Payer: United Healthcare VA CCN |
$117.00
|
|
|
MRI CHEST W/O DYE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 71550 26
|
| Hospital Charge Code |
9727155001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$192.43 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna of VT Commercial |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.00
|
| Rate for Payer: United Healthcare Commercial |
$247.00
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 71552 26
|
| Hospital Charge Code |
9727155201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna of VT Commercial |
$374.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$330.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$315.20
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.20
|
| Rate for Payer: Multiplan Commercial |
$366.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.90
|
| Rate for Payer: United Healthcare Commercial |
$374.30
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
IP
|
$4,226.99
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
6107155201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,128.40 |
| Max. Negotiated Rate |
$4,015.64 |
| Rate for Payer: Aetna of VT Commercial |
$4,015.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,128.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,128.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,592.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,550.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,381.59
|
| Rate for Payer: Cash Price |
$2,113.50
|
| Rate for Payer: Cigna Commercial |
$3,381.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,381.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,381.59
|
| Rate for Payer: Multiplan Commercial |
$3,931.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,592.94
|
| Rate for Payer: United Healthcare Commercial |
$4,015.64
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 71552 26
|
| Hospital Charge Code |
9727155201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna of VT Commercial |
$374.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$352.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$174.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$352.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$237.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$334.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$319.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$177.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$313.23
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$315.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$315.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$177.30
|
| Rate for Payer: Multiplan Commercial |
$366.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$334.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$177.30
|
| Rate for Payer: United Healthcare Commercial |
$374.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.30
|
| Rate for Payer: United Healthcare VA CCN |
$177.30
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
OP
|
$4,226.99
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
6107155201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,616.06 |
| Max. Negotiated Rate |
$4,015.64 |
| Rate for Payer: Aetna of VT Commercial |
$4,015.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,616.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,872.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,616.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,544.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,592.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,423.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,902.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,360.46
|
| Rate for Payer: Cash Price |
$2,113.50
|
| Rate for Payer: Cash Price |
$2,113.50
|
| Rate for Payer: Cigna Commercial |
$3,381.59
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,381.59
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,381.59
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,902.15
|
| Rate for Payer: Multiplan Commercial |
$3,931.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,592.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,902.15
|
| Rate for Payer: United Healthcare Commercial |
$4,015.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,902.15
|
| Rate for Payer: United Healthcare VA CCN |
$1,902.15
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
OP
|
$3,189.89
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
61073721LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$626.68 |
| Max. Negotiated Rate |
$3,030.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$626.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,412.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,920.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,583.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,435.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,535.96
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cigna Commercial |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,551.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,435.45
|
| Rate for Payer: Multiplan Commercial |
$2,966.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,435.45
|
| Rate for Payer: United Healthcare Commercial |
$3,030.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,435.45
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
OP
|
$3,189.89
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
61073721RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$626.68 |
| Max. Negotiated Rate |
$3,030.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$626.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,412.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$626.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,920.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,583.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,435.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,535.96
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cigna Commercial |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,551.91
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,435.45
|
| Rate for Payer: Multiplan Commercial |
$2,966.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.41
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,435.45
|
| Rate for Payer: United Healthcare Commercial |
$3,030.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,435.45
|
| Rate for Payer: United Healthcare VA CCN |
$1,435.45
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
IP
|
$3,189.89
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
61073721RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,360.84 |
| Max. Negotiated Rate |
$3,030.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,360.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,360.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,679.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,551.91
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cigna Commercial |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,551.91
|
| Rate for Payer: Multiplan Commercial |
$2,966.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.41
|
| Rate for Payer: United Healthcare Commercial |
$3,030.40
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
IP
|
$3,189.89
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
61073721LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,360.84 |
| Max. Negotiated Rate |
$3,030.40 |
| Rate for Payer: Aetna of VT Commercial |
$3,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,360.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,360.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,711.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,679.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,551.91
|
| Rate for Payer: Cash Price |
$1,594.94
|
| Rate for Payer: Cigna Commercial |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,551.91
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,551.91
|
| Rate for Payer: Multiplan Commercial |
$2,966.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,711.41
|
| Rate for Payer: United Healthcare Commercial |
$3,030.40
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 73721 26
|
| Hospital Charge Code |
9727372101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$144.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$156.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
|
|
MRI JNT OF LWR EXTRE W/O DYE
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 73721 26
|
| Hospital Charge Code |
9727372101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna of VT Commercial |
$185.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$86.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$165.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$157.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.03
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$156.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$156.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$181.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$185.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare VA CCN |
$87.75
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 73723 26
|
| Hospital Charge Code |
9727372301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna of VT Commercial |
$293.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$276.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$186.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$250.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$139.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.66
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$247.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$247.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$139.05
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.05
|
| Rate for Payer: United Healthcare VA CCN |
$139.05
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$6,344.64
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
61073723RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4,695.67 |
| Max. Negotiated Rate |
$6,027.41 |
| Rate for Payer: Aetna of VT Commercial |
$6,027.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,695.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,695.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,392.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,329.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,075.71
|
| Rate for Payer: Cash Price |
$3,172.32
|
| Rate for Payer: Cigna Commercial |
$5,075.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,075.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,075.71
|
| Rate for Payer: Multiplan Commercial |
$5,900.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,392.94
|
| Rate for Payer: United Healthcare Commercial |
$6,027.41
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 73723 26
|
| Hospital Charge Code |
9727372301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.61 |
| Max. Negotiated Rate |
$1,282.47 |
| Rate for Payer: Aetna of VT Commercial |
$290.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,282.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$99.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,282.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$135.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$159.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$159.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$159.49
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$151.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.61
|
| Rate for Payer: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$96.61
|
| Rate for Payer: United Healthcare Commercial |
$148.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.61
|
| Rate for Payer: United Healthcare VA CCN |
$96.61
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$6,344.64
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
61073723LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,282.47 |
| Max. Negotiated Rate |
$6,027.41 |
| Rate for Payer: Aetna of VT Commercial |
$6,027.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,282.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,810.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,282.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,819.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,392.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,139.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,855.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,043.99
|
| Rate for Payer: Cash Price |
$3,172.32
|
| Rate for Payer: Cash Price |
$3,172.32
|
| Rate for Payer: Cigna Commercial |
$5,075.71
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,075.71
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,075.71
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,855.09
|
| Rate for Payer: Multiplan Commercial |
$5,900.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,392.94
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,855.09
|
| Rate for Payer: United Healthcare Commercial |
$6,027.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,855.09
|
| Rate for Payer: United Healthcare VA CCN |
$2,855.09
|
|
