|
MRI JOINT UPR EXTREM W/O DYE
|
Facility
|
OP
|
$3,137.16
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
61073221RT
|
|
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 LT
|
| Hospital Charge Code |
61073221LT
|
|
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 EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,045.01
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
6107322301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,993.71 |
| Max. Negotiated Rate |
$3,842.76 |
| Rate for Payer: Aetna of VT Commercial |
$3,842.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,993.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,993.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,397.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,236.01
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,236.01
|
| Rate for Payer: Multiplan Commercial |
$3,761.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,438.26
|
| Rate for Payer: United Healthcare Commercial |
$3,842.76
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,045.01
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
61073223LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,993.71 |
| Max. Negotiated Rate |
$3,842.76 |
| Rate for Payer: Aetna of VT Commercial |
$3,842.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,993.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,993.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,397.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,236.01
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,236.01
|
| Rate for Payer: Multiplan Commercial |
$3,761.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,438.26
|
| Rate for Payer: United Healthcare Commercial |
$3,842.76
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,045.01
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
6107322301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.27 |
| Max. Negotiated Rate |
$3,842.76 |
| Rate for Payer: Aetna of VT Commercial |
$3,842.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,791.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,435.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,276.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,820.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,215.78
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,236.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,820.25
|
| Rate for Payer: Multiplan Commercial |
$3,761.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,438.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,820.25
|
| Rate for Payer: United Healthcare Commercial |
$3,842.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,820.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,820.25
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
CPT 73223 26
|
| Hospital Charge Code |
9727322301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,585.29 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,034.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,585.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,585.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,820.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,799.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,713.60
|
| Rate for Payer: Multiplan Commercial |
$1,992.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,820.70
|
| Rate for Payer: United Healthcare Commercial |
$2,034.90
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
CPT 73223 26
|
| Hospital Charge Code |
9727322301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$96.61 |
| Max. Negotiated Rate |
$2,013.48 |
| Rate for Payer: Aetna of VT Commercial |
$2,013.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,288.27
|
| 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 |
$1,288.27
|
| 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 |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$151.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$96.61
|
| Rate for Payer: Multiplan Commercial |
$1,992.06
|
| 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 UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
CPT 73223 26
|
| Hospital Charge Code |
9727322301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$948.69 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Aetna of VT Commercial |
$2,034.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,919.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$948.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,919.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,289.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,820.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,735.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$963.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,702.89
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,713.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,713.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$963.90
|
| Rate for Payer: Multiplan Commercial |
$1,992.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,820.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$963.90
|
| Rate for Payer: United Healthcare Commercial |
$2,034.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$963.90
|
| Rate for Payer: United Healthcare VA CCN |
$963.90
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,045.01
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
61073223LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.27 |
| Max. Negotiated Rate |
$3,842.76 |
| Rate for Payer: Aetna of VT Commercial |
$3,842.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,791.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,435.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,438.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,276.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,820.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,215.78
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cash Price |
$2,022.51
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,236.01
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,236.01
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,820.25
|
| Rate for Payer: Multiplan Commercial |
$3,761.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,438.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,820.25
|
| Rate for Payer: United Healthcare Commercial |
$3,842.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,820.25
|
| Rate for Payer: United Healthcare VA CCN |
$1,820.25
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$308.13
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
61073223RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$1,288.27 |
| Rate for Payer: Aetna of VT Commercial |
$292.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$136.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,288.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$249.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$138.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$244.96
|
| Rate for Payer: Cash Price |
$154.06
|
| Rate for Payer: Cash Price |
$154.06
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.50
|
| Rate for Payer: Martins Point Health Care Commercial |
$138.66
|
| Rate for Payer: Multiplan Commercial |
$286.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$138.66
|
| Rate for Payer: United Healthcare Commercial |
$292.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.66
|
| Rate for Payer: United Healthcare VA CCN |
$138.66
|
|
|
MRI JOINT UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$308.13
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
61073223RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Aetna of VT Commercial |
$292.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$261.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$258.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$246.50
|
| Rate for Payer: Cash Price |
$154.06
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$246.50
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$246.50
|
| Rate for Payer: Multiplan Commercial |
$286.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$261.91
|
| Rate for Payer: United Healthcare Commercial |
$292.72
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 73719 26
|
| Hospital Charge Code |
9727371901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$173.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$196.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$187.20
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
61073719LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$844.67 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,869.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,540.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,418.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,899.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,355.53
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,899.36
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,899.36
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 73719 26
|
| Hospital Charge Code |
9727371901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$844.67 |
| Rate for Payer: Aetna of VT Commercial |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$74.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$101.54
|
| 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 |
$83.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$119.75
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$113.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.53
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$600.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$72.53
|
| Rate for Payer: United Healthcare Commercial |
$111.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.53
|
| Rate for Payer: United Healthcare VA CCN |
$72.53
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
6107371901
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,123.81 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,376.63
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
61073719RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$844.67 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,869.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,540.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,418.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,899.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,355.53
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,899.36
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,899.36
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
6107371901
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$844.67 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,869.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$844.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,540.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,418.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,899.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,355.53
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,899.36
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,899.36
|
| Rate for Payer: United Healthcare VA CCN |
$1,899.36
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 73719 26
|
| Hospital Charge Code |
9727371901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of VT Commercial |
$222.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$209.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$140.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$198.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$189.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$105.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$186.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$187.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$187.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$217.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.30
|
| Rate for Payer: United Healthcare VA CCN |
$105.30
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
61073719LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,123.81 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,376.63
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
|
|
MRI LOWER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$4,220.79
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
61073719RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,123.81 |
| Max. Negotiated Rate |
$4,009.75 |
| Rate for Payer: Aetna of VT Commercial |
$4,009.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,123.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,587.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,545.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,376.63
|
| Rate for Payer: Cash Price |
$2,110.40
|
| Rate for Payer: Cigna Commercial |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,376.63
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,376.63
|
| Rate for Payer: Multiplan Commercial |
$3,925.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,587.67
|
| Rate for Payer: United Healthcare Commercial |
$4,009.75
|
|
|
MRI LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 73718 26
|
| Hospital Charge Code |
9727371801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$143.58 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna of VT Commercial |
$184.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$143.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$164.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$162.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$155.20
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$155.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$180.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.90
|
| Rate for Payer: United Healthcare Commercial |
$184.30
|
|
|
MRI LOWER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$3,162.75
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
6107371801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$722.06 |
| Max. Negotiated Rate |
$3,004.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,004.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$722.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,400.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$722.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,903.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,688.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,561.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,423.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,514.39
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cigna Commercial |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,530.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,423.24
|
| Rate for Payer: Multiplan Commercial |
$2,941.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,688.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,423.24
|
| Rate for Payer: United Healthcare Commercial |
$3,004.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,423.24
|
| Rate for Payer: United Healthcare VA CCN |
$1,423.24
|
|
|
MRI LOWER EXTREMITY W/O CONTR
|
Facility
|
OP
|
$3,162.75
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
61073718RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$722.06 |
| Max. Negotiated Rate |
$3,004.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,004.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$722.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,400.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$722.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,903.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,688.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,561.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,423.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,514.39
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cigna Commercial |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,530.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,423.24
|
| Rate for Payer: Multiplan Commercial |
$2,941.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,688.34
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,423.24
|
| Rate for Payer: United Healthcare Commercial |
$3,004.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,423.24
|
| Rate for Payer: United Healthcare VA CCN |
$1,423.24
|
|
|
MRI LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$3,162.75
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
61073718RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,340.75 |
| Max. Negotiated Rate |
$3,004.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,004.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,340.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,340.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,688.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,656.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,530.20
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cigna Commercial |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,530.20
|
| Rate for Payer: Multiplan Commercial |
$2,941.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,688.34
|
| Rate for Payer: United Healthcare Commercial |
$3,004.61
|
|
|
MRI LOWER EXTREMITY W/O CONTR
|
Facility
|
IP
|
$3,162.75
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
61073718LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,340.75 |
| Max. Negotiated Rate |
$3,004.61 |
| Rate for Payer: Aetna of VT Commercial |
$3,004.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,340.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,340.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,688.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,656.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,530.20
|
| Rate for Payer: Cash Price |
$1,581.38
|
| Rate for Payer: Cigna Commercial |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,530.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,530.20
|
| Rate for Payer: Multiplan Commercial |
$2,941.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,688.34
|
| Rate for Payer: United Healthcare Commercial |
$3,004.61
|
|
