|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$2,082.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,082.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,984.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,984.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.30
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$243.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.62
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,458.98 |
| Max. Negotiated Rate |
$7,007.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,195.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,900.80
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,474.77 |
| Max. Negotiated Rate |
$4,460.25 |
| Rate for Payer: Aetna of VT Commercial |
$4,460.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,474.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,474.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,990.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,943.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,756.00
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,756.00
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,990.75
|
| Rate for Payer: United Healthcare Commercial |
$4,460.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$8,746.70 |
| Rate for Payer: Aetna of VT Commercial |
$8,746.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,336.35
|
| 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 |
$8,336.35
|
| 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 |
$4,652.50
|
| Rate for Payer: Cash Price |
$4,652.50
|
| 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 |
$8,653.65
|
| 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
|
$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
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$692.73 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna of VT Commercial |
$889.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$748.80
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,355.85 |
| Max. Negotiated Rate |
$7,198.15 |
| Rate for Payer: Aetna of VT Commercial |
$7,198.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,355.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,561.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,440.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,137.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,409.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,023.72
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cigna Commercial |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,409.65
|
| Rate for Payer: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,440.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare Commercial |
$7,198.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare VA CCN |
$3,409.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,948.39 |
| Max. Negotiated Rate |
$6,324.15 |
| Rate for Payer: Aetna of VT Commercial |
$6,324.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,964.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,948.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,964.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,007.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,658.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,392.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,995.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,292.31
|
| Rate for Payer: Cash Price |
$3,328.50
|
| Rate for Payer: Cigna Commercial |
$5,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,325.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,995.65
|
| Rate for Payer: Multiplan Commercial |
$6,191.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,658.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,995.65
|
| Rate for Payer: United Healthcare Commercial |
$6,324.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,995.65
|
| Rate for Payer: United Healthcare VA CCN |
$2,995.65
|
|
|
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
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,108.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,108.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$251.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$622.93
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$424.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.05
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare Commercial |
$375.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare VA CCN |
$244.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$4,962.26 |
| Rate for Payer: Aetna of VT Commercial |
$4,962.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.16
|
| Rate for Payer: Cash Price |
$2,639.50
|
| Rate for Payer: Cash Price |
$2,639.50
|
| Rate for Payer: Cigna Commercial |
$394.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.92
|
| Rate for Payer: Multiplan Commercial |
$4,909.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare Commercial |
$349.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare VA CCN |
$226.92
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$4,413.30 |
| Rate for Payer: Aetna of VT Commercial |
$4,413.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,011.26
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$323.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,141.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,141.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.30
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare Commercial |
$286.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare VA CCN |
$186.28
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$522.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$709.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$954.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$530.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$937.30
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.55
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare VA CCN |
$530.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,639.32 |
| Max. Negotiated Rate |
$2,104.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
|
|
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
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
9825233201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$3,355.80 |
| Rate for Payer: Aetna of VT Commercial |
$3,355.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,198.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$148.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,198.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$202.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,016.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,016.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$165.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,016.09
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$250.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$355.32
|
| Rate for Payer: Multiplan Commercial |
$3,320.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$144.30
|
| Rate for Payer: United Healthcare Commercial |
$221.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.30
|
| Rate for Payer: United Healthcare VA CCN |
$144.30
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,079.42 |
| Max. Negotiated Rate |
$4,460.25 |
| Rate for Payer: Aetna of VT Commercial |
$4,460.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,079.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,826.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,990.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,802.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,112.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,732.53
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,756.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,112.75
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,990.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare Commercial |
$4,460.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare VA CCN |
$2,112.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$4,456.54 |
| Rate for Payer: Aetna of VT Commercial |
$4,456.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.16
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cigna Commercial |
$394.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.92
|
| Rate for Payer: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare Commercial |
$349.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare VA CCN |
$226.92
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$398.17 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna of VT Commercial |
$511.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$398.17
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$398.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$457.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$451.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$430.40
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cigna Commercial |
$430.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$430.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$430.40
|
| Rate for Payer: Multiplan Commercial |
$500.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.30
|
| Rate for Payer: United Healthcare Commercial |
$511.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$532.87 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of VT Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$532.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$532.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$604.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.00
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,633.28 |
| Max. Negotiated Rate |
$3,380.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,380.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,988.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,846.40
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,846.40
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
5105228501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$576.29 |
| Rate for Payer: Aetna of VT Commercial |
$568.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$542.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$542.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$254.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$576.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$208.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.29
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$315.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.05
|
| Rate for Payer: Multiplan Commercial |
$562.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.68
|
| Rate for Payer: United Healthcare Commercial |
$279.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.68
|
| Rate for Payer: United Healthcare VA CCN |
$181.68
|
|
|
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
|
$1,779.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
5105231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,690.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,690.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,593.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$787.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,593.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,070.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,512.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,440.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$800.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,414.31
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,423.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$800.55
|
| Rate for Payer: Multiplan Commercial |
$1,654.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,512.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$800.55
|
| Rate for Payer: United Healthcare Commercial |
$1,690.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.55
|
| Rate for Payer: United Healthcare VA CCN |
$800.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.50 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna of VT Commercial |
$791.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$666.40
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
|
