|
MRI SPINE CERVICAL W/O & W/DYE
|
Facility
|
OP
|
$4,586.31
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
6127215601
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$960.27 |
| Max. Negotiated Rate |
$4,356.99 |
| Rate for Payer: Aetna of VT Commercial |
$4,356.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$960.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,031.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$960.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,760.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,898.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,714.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,063.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,646.12
|
| Rate for Payer: Cash Price |
$2,293.16
|
| Rate for Payer: Cash Price |
$2,293.16
|
| Rate for Payer: Cigna Commercial |
$3,669.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,669.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,669.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,063.84
|
| Rate for Payer: Multiplan Commercial |
$4,265.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,898.36
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,063.84
|
| Rate for Payer: United Healthcare Commercial |
$4,356.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,063.84
|
| Rate for Payer: United Healthcare VA CCN |
$2,063.84
|
|
|
MRI SPINE CERVICAL W/O & W/DYE
|
Facility
|
IP
|
$4,586.31
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
6127215601
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$3,394.33 |
| Max. Negotiated Rate |
$4,356.99 |
| Rate for Payer: Aetna of VT Commercial |
$4,356.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,394.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,394.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,898.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,852.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,669.05
|
| Rate for Payer: Cash Price |
$2,293.16
|
| Rate for Payer: Cigna Commercial |
$3,669.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,669.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,669.05
|
| Rate for Payer: Multiplan Commercial |
$4,265.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,898.36
|
| Rate for Payer: United Healthcare Commercial |
$4,356.99
|
|
|
MRI SPINE CERVICAL W/O & W/DYE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 72156 26
|
| Hospital Charge Code |
9727215601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.20
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
|
|
MRI SPINE CNL THORACIC W/O DYE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 72146 26
|
| Hospital Charge Code |
9727214601
|
|
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 SPINE CNL THORACIC W/O DYE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 72146 26
|
| Hospital Charge Code |
9727214601
|
|
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 SPINE CNL THORACIC W/O DYE
|
Facility
|
IP
|
$3,222.98
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
6127214601
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,385.33 |
| Max. Negotiated Rate |
$3,061.83 |
| Rate for Payer: Aetna of VT Commercial |
$3,061.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,385.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,385.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,739.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,707.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,578.38
|
| Rate for Payer: Cash Price |
$1,611.49
|
| Rate for Payer: Cigna Commercial |
$2,578.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,578.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,578.38
|
| Rate for Payer: Multiplan Commercial |
$2,997.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,739.53
|
| Rate for Payer: United Healthcare Commercial |
$3,061.83
|
|
|
MRI SPINE CNL THORACIC W/O DYE
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 72146 26
|
| Hospital Charge Code |
9727214601
|
|
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 |
$547.22
|
| 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 |
$547.22
|
| 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 SPINE CNL THORACIC W/O DYE
|
Facility
|
OP
|
$3,222.98
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
6127214601
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$547.22 |
| Max. Negotiated Rate |
$3,061.83 |
| Rate for Payer: Aetna of VT Commercial |
$3,061.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,427.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,940.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,739.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,610.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,450.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,562.27
|
| Rate for Payer: Cash Price |
$1,611.49
|
| Rate for Payer: Cash Price |
$1,611.49
|
| Rate for Payer: Cigna Commercial |
$2,578.38
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,578.38
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,578.38
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,450.34
|
| Rate for Payer: Multiplan Commercial |
$2,997.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,739.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,450.34
|
| Rate for Payer: United Healthcare Commercial |
$3,061.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,450.34
|
| Rate for Payer: United Healthcare VA CCN |
$1,450.34
|
|
|
MRI SPINE LUMBAR W/O & W/DYE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 72158 26
|
| Hospital Charge Code |
9727215801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.20
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
|
|
MRI SPINE LUMBAR W/O & W/DYE
|
Facility
|
OP
|
$4,490.66
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
6127215801
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$957.37 |
| Max. Negotiated Rate |
$4,266.13 |
| Rate for Payer: Aetna of VT Commercial |
$4,266.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$957.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,988.91
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$957.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,703.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,817.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,637.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,020.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,570.07
|
| Rate for Payer: Cash Price |
$2,245.33
|
| Rate for Payer: Cash Price |
$2,245.33
|
| Rate for Payer: Cigna Commercial |
$3,592.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,592.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,592.53
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,020.80
|
| Rate for Payer: Multiplan Commercial |
$4,176.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,817.06
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,020.80
|
| Rate for Payer: United Healthcare Commercial |
$4,266.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,020.80
|
| Rate for Payer: United Healthcare VA CCN |
$2,020.80
|
|
|
MRI SPINE LUMBAR W/O & W/DYE
|
Facility
|
IP
|
$4,490.66
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
6127215801
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$3,323.54 |
| Max. Negotiated Rate |
$4,266.13 |
| Rate for Payer: Aetna of VT Commercial |
$4,266.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,323.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,817.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,772.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,592.53
|
| Rate for Payer: Cash Price |
$2,245.33
|
| Rate for Payer: Cigna Commercial |
$3,592.53
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,592.53
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,592.53
|
| Rate for Payer: Multiplan Commercial |
$4,176.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,817.06
|
| Rate for Payer: United Healthcare Commercial |
$4,266.13
|
|
|
MRI SPINE LUMBAR W/O & W/DYE
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 72158 26
|
| Hospital Charge Code |
9727215801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$957.37 |
| Rate for Payer: Aetna of VT Commercial |
$309.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$957.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$957.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$170.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$170.00
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$161.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.92
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$600.00
|
| Rate for Payer: United Healthcare Commercial |
$158.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.91
|
| Rate for Payer: United Healthcare VA CCN |
$102.91
|
|
|
MRI SPINE LUMBAR W/O & W/DYE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 72158 26
|
| Hospital Charge Code |
9727215801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.56
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.05
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare VA CCN |
$148.05
|
|
|
MRI SPINE THORACIC W/O & W/DYE
|
Facility
|
IP
|
$4,680.92
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
6127215701
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$3,464.35 |
| Max. Negotiated Rate |
$4,446.87 |
| Rate for Payer: Aetna of VT Commercial |
$4,446.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,464.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,464.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,978.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,931.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,744.74
|
| Rate for Payer: Cash Price |
$2,340.46
|
| Rate for Payer: Cigna Commercial |
$3,744.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,744.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,744.74
|
| Rate for Payer: Multiplan Commercial |
$4,353.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,978.78
|
| Rate for Payer: United Healthcare Commercial |
$4,446.87
|
|
|
MRI SPINE THORACIC W/O & W/DYE
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 72157 26
|
| Hospital Charge Code |
9727215701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$243.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$276.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$263.20
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
|
|
MRI SPINE THORACIC W/O & W/DYE
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 72157 26
|
| Hospital Charge Code |
9727215701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna of VT Commercial |
$312.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$198.06
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$279.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$148.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$261.56
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$263.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$263.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$148.05
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$279.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare Commercial |
$312.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.05
|
| Rate for Payer: United Healthcare VA CCN |
$148.05
|
|
|
MRI SPINE THORACIC W/O & W/DYE
|
Facility
|
OP
|
$4,680.92
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
6127215701
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$963.17 |
| Max. Negotiated Rate |
$4,446.87 |
| Rate for Payer: Aetna of VT Commercial |
$4,446.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$963.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,073.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$963.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,817.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,978.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,791.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,106.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,721.33
|
| Rate for Payer: Cash Price |
$2,340.46
|
| Rate for Payer: Cash Price |
$2,340.46
|
| Rate for Payer: Cigna Commercial |
$3,744.74
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,744.74
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,744.74
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,106.41
|
| Rate for Payer: Multiplan Commercial |
$4,353.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,978.78
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,106.41
|
| Rate for Payer: United Healthcare Commercial |
$4,446.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,106.41
|
| Rate for Payer: United Healthcare VA CCN |
$2,106.41
|
|
|
MRI SPINE THORACIC W/O & W/DYE
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 72157 26
|
| Hospital Charge Code |
9727215701
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$963.17 |
| Rate for Payer: Aetna of VT Commercial |
$309.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$963.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$963.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$144.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$184.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$184.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$118.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.36
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$161.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$102.92
|
| Rate for Payer: Multiplan Commercial |
$305.97
|
| 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 |
$158.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.91
|
| Rate for Payer: United Healthcare VA CCN |
$102.91
|
|
|
MRI UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,280.77
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
61073219LT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.09 |
| Max. Negotiated Rate |
$4,066.73 |
| Rate for Payer: Aetna of VT Commercial |
$4,066.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,895.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,577.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,638.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,467.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,926.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,403.21
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cigna Commercial |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,424.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,926.35
|
| Rate for Payer: Multiplan Commercial |
$3,981.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,638.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare Commercial |
$4,066.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,926.35
|
|
|
MRI UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 73219 26
|
| Hospital Charge Code |
9727321901
|
|
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 UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$4,280.77
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
6107321901
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,168.20 |
| Max. Negotiated Rate |
$4,066.73 |
| Rate for Payer: Aetna of VT Commercial |
$4,066.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,168.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,168.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,638.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,424.62
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cigna Commercial |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,424.62
|
| Rate for Payer: Multiplan Commercial |
$3,981.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,638.65
|
| Rate for Payer: United Healthcare Commercial |
$4,066.73
|
|
|
MRI UPPER EXTREMITY W/CONTRAST
|
Facility
|
IP
|
$4,280.77
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
61073219RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,168.20 |
| Max. Negotiated Rate |
$4,066.73 |
| Rate for Payer: Aetna of VT Commercial |
$4,066.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,168.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,168.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,638.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,595.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,424.62
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cigna Commercial |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,424.62
|
| Rate for Payer: Multiplan Commercial |
$3,981.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,638.65
|
| Rate for Payer: United Healthcare Commercial |
$4,066.73
|
|
|
MRI UPPER EXTREMITY W/CONTRAST
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 73219 26
|
| Hospital Charge Code |
9727321901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$1,148.09 |
| Rate for Payer: Aetna of VT Commercial |
$220.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,148.09
|
| 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 |
$1,148.09
|
| 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 |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$120.28
|
| 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 |
$120.28
|
| 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 |
$114.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$72.53
|
| Rate for Payer: Multiplan Commercial |
$218.55
|
| 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 UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,280.77
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
6107321901
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.09 |
| Max. Negotiated Rate |
$4,066.73 |
| Rate for Payer: Aetna of VT Commercial |
$4,066.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,895.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,577.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,638.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,467.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,926.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,403.21
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cigna Commercial |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,424.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,926.35
|
| Rate for Payer: Multiplan Commercial |
$3,981.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,638.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare Commercial |
$4,066.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,926.35
|
|
|
MRI UPPER EXTREMITY W/CONTRAST
|
Facility
|
OP
|
$4,280.77
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
61073219RT
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,148.09 |
| Max. Negotiated Rate |
$4,066.73 |
| Rate for Payer: Aetna of VT Commercial |
$4,066.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,895.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,148.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,577.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,638.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,467.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,926.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,403.21
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cash Price |
$2,140.39
|
| Rate for Payer: Cigna Commercial |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,424.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,424.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,926.35
|
| Rate for Payer: Multiplan Commercial |
$3,981.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,638.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare Commercial |
$4,066.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,926.35
|
| Rate for Payer: United Healthcare VA CCN |
$1,926.35
|
|
