|
CYSTATIN C
|
Professional
|
Both
|
$74.45
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
3008261001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna of VT Commercial |
$69.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$19.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$25.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$24.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$24.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$24.31
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cash Price |
$37.23
|
| Rate for Payer: Cigna Commercial |
$22.61
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$18.52
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$18.52
|
| Rate for Payer: Martins Point Health Care Commercial |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$69.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare Commercial |
$28.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare VA CCN |
$18.52
|
|
|
CYSTOMETROGRAM W/VP&UP
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
9825172901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$341.42 |
| Max. Negotiated Rate |
$740.72 |
| Rate for Payer: Aetna of VT Commercial |
$740.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$351.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$477.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$482.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$482.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$392.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$482.50
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$641.11
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$553.39
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$553.39
|
| Rate for Payer: Martins Point Health Care Commercial |
$341.42
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$484.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$341.42
|
| Rate for Payer: United Healthcare Commercial |
$525.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.42
|
| Rate for Payer: United Healthcare VA CCN |
$341.42
|
|
|
CYSTOMETROGRAM W/VP&UP
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
9825172901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$349.01 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$349.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$705.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$474.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$638.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$354.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$626.46
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$354.60
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$354.60
|
| Rate for Payer: United Healthcare VA CCN |
$354.60
|
|
|
CYSTOMETROGRAM W/VP&UP
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
9825172901
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna of VT Commercial |
$748.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$669.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$661.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$630.40
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$630.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$630.40
|
| Rate for Payer: Multiplan Commercial |
$732.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$669.80
|
| Rate for Payer: United Healthcare Commercial |
$748.60
|
|
|
CYSTOSCOPE SINGLE USE 16 FR
|
Facility
|
OP
|
$595.00
|
|
| Hospital Charge Code |
2720074941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.53 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna of VT Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$263.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$358.19
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$481.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$473.02
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$565.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare VA CCN |
$267.75
|
|
|
CYSTOSCOPE SINGLE USE 16 FR
|
Facility
|
IP
|
$595.00
|
|
| Hospital Charge Code |
2720074941
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna of VT Commercial |
$565.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$440.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$440.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$505.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$476.00
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$476.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$553.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$505.75
|
| Rate for Payer: United Healthcare Commercial |
$565.25
|
|
|
CYSTOSCOPY
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9825200001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$360.02 |
| Rate for Payer: Aetna of VT Commercial |
$360.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.43
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$129.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare Commercial |
$114.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare VA CCN |
$74.35
|
|
|
CYSTOSCOPY
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$1,055.62 |
| Rate for Payer: Aetna of VT Commercial |
$1,055.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.43
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$129.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare Commercial |
$114.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare VA CCN |
$74.35
|
|
|
CYSTOSCOPY
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9825200001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.49
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.35
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare VA CCN |
$172.35
|
|
|
CYSTOSCOPY
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
5105200001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$547.67 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of VT Commercial |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$547.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$547.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$629.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$621.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$592.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$629.00
|
| Rate for Payer: United Healthcare Commercial |
$703.00
|
|
|
CYSTOSCOPY
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$360.02 |
| Rate for Payer: Aetna of VT Commercial |
$360.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.43
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$129.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare Commercial |
$114.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare VA CCN |
$74.35
|
|
|
CYSTOSCOPY
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$497.38 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,066.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$497.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,006.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$676.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$909.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$505.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$892.78
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$898.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$505.35
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$954.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$505.35
|
| Rate for Payer: United Healthcare Commercial |
$1,066.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$505.35
|
| Rate for Payer: United Healthcare VA CCN |
$505.35
|
|
|
CYSTOSCOPY
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$831.13 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,066.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$831.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$831.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$954.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$943.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$898.40
|
| Rate for Payer: Cash Price |
$561.50
|
| Rate for Payer: Cigna Commercial |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$898.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$898.40
|
| Rate for Payer: Multiplan Commercial |
$1,044.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$954.55
|
| Rate for Payer: United Healthcare Commercial |
$1,066.85
|
|
|
CYSTOSCOPY
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
5105200001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.35 |
| Max. Negotiated Rate |
$695.60 |
| Rate for Payer: Aetna of VT Commercial |
$695.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$76.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$355.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$85.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$355.43
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$129.47
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare Commercial |
$114.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.35
|
| Rate for Payer: United Healthcare VA CCN |
$74.35
|
|
|
CYSTOSCOPY
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9825200001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$283.46 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$306.40
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
|
|
CYSTOSCOPY
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$283.46 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$283.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$321.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$306.40
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
|
|
CYSTOSCOPY
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
5105200001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.75 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of VT Commercial |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$327.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$662.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$629.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$599.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$588.30
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$592.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$592.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$333.00
|
| Rate for Payer: Multiplan Commercial |
$688.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$629.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$333.00
|
| Rate for Payer: United Healthcare Commercial |
$703.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.00
|
| Rate for Payer: United Healthcare VA CCN |
$333.00
|
|
|
CYSTOSCOPY
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
9605200002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.63 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna of VT Commercial |
$363.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$343.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$230.57
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$325.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$310.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$304.49
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$306.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$306.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$172.35
|
| Rate for Payer: Multiplan Commercial |
$356.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare Commercial |
$363.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.35
|
| Rate for Payer: United Healthcare VA CCN |
$172.35
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$6,933.44 |
| Rate for Payer: Aetna of VT Commercial |
$6,933.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,608.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,608.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$1,813.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,813.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$1,793.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9825231001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna of VT Commercial |
$415.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.42
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.65
|
| Rate for Payer: Multiplan Commercial |
$406.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$415.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare VA CCN |
$196.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$617.98 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Aetna of VT Commercial |
$793.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$617.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$617.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.00
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$668.00
|
| Rate for Payer: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$709.75
|
| Rate for Payer: United Healthcare Commercial |
$793.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9825231001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$323.42 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna of VT Commercial |
$415.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$323.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$367.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$349.60
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.60
|
| Rate for Payer: Multiplan Commercial |
$406.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.45
|
| Rate for Payer: United Healthcare Commercial |
$415.15
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$387.09 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Aetna of VT Commercial |
$830.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$387.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$526.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$742.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$707.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$694.83
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$699.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$393.30
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$393.30
|
| Rate for Payer: United Healthcare Commercial |
$830.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.30
|
| Rate for Payer: United Healthcare VA CCN |
$393.30
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
9825226501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$553.18 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,186.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,118.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$553.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,118.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$751.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,061.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,011.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$562.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$992.96
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$999.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$562.05
|
| Rate for Payer: Multiplan Commercial |
$1,161.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,061.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$562.05
|
| Rate for Payer: United Healthcare Commercial |
$1,186.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$562.05
|
| Rate for Payer: United Healthcare VA CCN |
$562.05
|
|
