|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 73723 26
|
| Hospital Charge Code |
9727372301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$228.69 |
| 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 |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$262.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$259.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$247.20
|
| 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: Multiplan Commercial |
$287.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$262.65
|
| Rate for Payer: United Healthcare Commercial |
$293.55
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$6,344.64
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
61073723RT
|
|
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
|
|
|
MRI JOINT LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$6,344.64
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
61073723LT
|
|
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 OF LWR EXTR W/DYE
|
Facility
|
IP
|
$3,815.66
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
61073722LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,823.97 |
| Max. Negotiated Rate |
$3,624.88 |
| Rate for Payer: Aetna of VT Commercial |
$3,624.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,823.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,823.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,243.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,205.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,052.53
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cigna Commercial |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,052.53
|
| Rate for Payer: Multiplan Commercial |
$3,548.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,243.31
|
| Rate for Payer: United Healthcare Commercial |
$3,624.88
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 73722 26
|
| Hospital Charge Code |
9727372201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.82
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare VA CCN |
$105.75
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 73722 26
|
| Hospital Charge Code |
9727372201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.92 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
OP
|
$3,815.66
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
61073722LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,068.62 |
| Max. Negotiated Rate |
$3,624.88 |
| Rate for Payer: Aetna of VT Commercial |
$3,624.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,068.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,689.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,068.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,297.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,243.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,090.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,717.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,033.45
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cigna Commercial |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,052.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,717.05
|
| Rate for Payer: Multiplan Commercial |
$3,548.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,243.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,717.05
|
| Rate for Payer: United Healthcare Commercial |
$3,624.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,717.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,717.05
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
OP
|
$3,815.66
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
61073722RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,068.62 |
| Max. Negotiated Rate |
$3,624.88 |
| Rate for Payer: Aetna of VT Commercial |
$3,624.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,068.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,689.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,068.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,297.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,243.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,090.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,717.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,033.45
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cigna Commercial |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,052.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,717.05
|
| Rate for Payer: Multiplan Commercial |
$3,548.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,243.31
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,717.05
|
| Rate for Payer: United Healthcare Commercial |
$3,624.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,717.05
|
| Rate for Payer: United Healthcare VA CCN |
$1,717.05
|
|
|
MRI JOINT OF LWR EXTR W/DYE
|
Facility
|
IP
|
$3,815.66
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
61073722RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,823.97 |
| Max. Negotiated Rate |
$3,624.88 |
| Rate for Payer: Aetna of VT Commercial |
$3,624.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,823.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,823.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,243.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,205.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,052.53
|
| Rate for Payer: Cash Price |
$1,907.83
|
| Rate for Payer: Cigna Commercial |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,052.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,052.53
|
| Rate for Payer: Multiplan Commercial |
$3,548.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,243.31
|
| Rate for Payer: United Healthcare Commercial |
$3,624.88
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
IP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
61073222LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,484.04 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,685.09
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 73222 26
|
| Hospital Charge Code |
9727322201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.92 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$188.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
IP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
6107322201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,484.04 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,685.09
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
OP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
6107322201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,065.72 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,486.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,020.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,718.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,510.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,668.31
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,510.36
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
OP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
61073222RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,065.72 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,486.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,020.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,718.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,510.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,668.31
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,510.36
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
OP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
61073222LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,065.72 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,486.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,020.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,718.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,510.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,668.31
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,510.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,510.36
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 73222 26
|
| Hospital Charge Code |
9727322201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna of VT Commercial |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$104.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$210.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$141.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$199.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$190.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.82
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$188.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$188.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare Commercial |
$223.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: United Healthcare VA CCN |
$105.75
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Facility
|
IP
|
$3,356.36
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
61073222RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,484.04 |
| Max. Negotiated Rate |
$3,188.54 |
| Rate for Payer: Aetna of VT Commercial |
$3,188.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,484.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,852.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,685.09
|
| Rate for Payer: Cash Price |
$1,678.18
|
| Rate for Payer: Cigna Commercial |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,685.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,685.09
|
| Rate for Payer: Multiplan Commercial |
$3,121.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,852.91
|
| Rate for Payer: United Healthcare Commercial |
$3,188.54
|
|
|
MRI JOINT UPR EXTREM W/CONTR
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 73222 26
|
| Hospital Charge Code |
9727322201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$1,065.72 |
| Rate for Payer: Aetna of VT Commercial |
$220.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$75.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,065.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$119.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$83.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.75
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$114.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.84
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$600.00
|
| Rate for Payer: United Healthcare Commercial |
$112.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.85
|
| Rate for Payer: United Healthcare VA CCN |
$72.85
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$3,137.16
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
61073221LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.13 |
| Max. Negotiated Rate |
$2,980.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,389.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,888.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,541.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,411.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,494.04
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cigna Commercial |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,411.72
|
| Rate for Payer: Multiplan Commercial |
$2,917.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,411.72
|
| Rate for Payer: United Healthcare Commercial |
$2,980.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,411.72
|
| Rate for Payer: United Healthcare VA CCN |
$1,411.72
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
CPT 73221 26
|
| Hospital Charge Code |
9727322101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$60.73 |
| Max. Negotiated Rate |
$628.13 |
| Rate for Payer: Aetna of VT Commercial |
$186.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$62.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$85.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$99.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$69.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.75
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$95.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$60.73
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| 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 |
$93.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.73
|
| Rate for Payer: United Healthcare VA CCN |
$60.73
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 73221 26
|
| Hospital Charge Code |
9727322101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$146.54 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna of VT Commercial |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$146.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$146.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$158.40
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$158.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.30
|
| Rate for Payer: United Healthcare Commercial |
$188.10
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 73221 26
|
| Hospital Charge Code |
9727322101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna of VT Commercial |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$177.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$87.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$177.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$119.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$160.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$89.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$157.41
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$158.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$158.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$158.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$89.10
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$188.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.10
|
| Rate for Payer: United Healthcare VA CCN |
$89.10
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
IP
|
$3,137.16
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
61073221RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,321.81 |
| Max. Negotiated Rate |
$2,980.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,321.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,321.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,635.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,509.73
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cigna Commercial |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.73
|
| Rate for Payer: Multiplan Commercial |
$2,917.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.59
|
| Rate for Payer: United Healthcare Commercial |
$2,980.30
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$3,137.16
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
6107322101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$628.13 |
| Max. Negotiated Rate |
$2,980.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,389.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$628.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,888.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,541.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,411.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,494.04
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cigna Commercial |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,411.72
|
| Rate for Payer: Multiplan Commercial |
$2,917.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.59
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,411.72
|
| Rate for Payer: United Healthcare Commercial |
$2,980.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,411.72
|
| Rate for Payer: United Healthcare VA CCN |
$1,411.72
|
|
|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
IP
|
$3,137.16
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
6107322101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,321.81 |
| Max. Negotiated Rate |
$2,980.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,980.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,321.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,321.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,666.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,635.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,509.73
|
| Rate for Payer: Cash Price |
$1,568.58
|
| Rate for Payer: Cigna Commercial |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,509.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,509.73
|
| Rate for Payer: Multiplan Commercial |
$2,917.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,666.59
|
| Rate for Payer: United Healthcare Commercial |
$2,980.30
|
|
