|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$618.52 |
| Rate for Payer: Aetna of VT Commercial |
$618.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.95
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$394.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$227.27
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare Commercial |
$349.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare VA CCN |
$227.27
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$842.23 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,081.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$842.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$842.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$967.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$955.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$910.40
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cigna Commercial |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$910.40
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$967.30
|
| Rate for Payer: United Healthcare Commercial |
$1,081.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$586.84 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$586.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$797.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,126.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,073.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.38
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,060.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$596.25
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,126.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare Commercial |
$1,258.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare VA CCN |
$596.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna of VT Commercial |
$676.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.05
|
| 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 |
$645.05
|
| 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 |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| 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 |
$669.60
|
| 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
|
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
|
IP
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,991.23 |
| Max. Negotiated Rate |
$6,406.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,406.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,732.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,664.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,395.20
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna Commercial |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,395.20
|
| Rate for Payer: Multiplan Commercial |
$6,271.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,732.40
|
| Rate for Payer: United Healthcare Commercial |
$6,406.80
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$981.02 |
| 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 |
$1,984.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$981.02
|
| 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 |
$1,333.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,794.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$996.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,760.92
|
| 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: Martins Point Health Care Commercial |
$996.75
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$996.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$996.75
|
| Rate for Payer: United Healthcare VA CCN |
$996.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.02 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna of VT Commercial |
$1,081.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$504.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$685.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$967.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$921.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$512.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$904.71
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cigna Commercial |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$910.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$910.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$512.10
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$967.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$512.10
|
| Rate for Payer: United Healthcare Commercial |
$1,081.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.10
|
| Rate for Payer: United Healthcare VA CCN |
$512.10
|
|
|
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
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$872.58 |
| 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 |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$943.20
|
| 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: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,266.83 |
| 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 |
$6,608.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,266.83
|
| 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 |
$4,440.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,974.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,319.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,863.92
|
| 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: Martins Point Health Care Commercial |
$3,319.20
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,319.20
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,319.20
|
| Rate for Payer: United Healthcare VA CCN |
$3,319.20
|
|
|
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
|
IP
|
$3,570.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
9825233201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,642.16 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,391.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,642.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,642.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,034.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,998.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,856.00
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$2,856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,320.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,034.50
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
5105228501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.76 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Aetna of VT Commercial |
$574.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$447.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$447.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$514.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$508.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$484.00
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$484.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$484.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$562.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$514.25
|
| Rate for Payer: United Healthcare Commercial |
$574.75
|
|
|
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
|
|
|
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
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$478.84 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Aetna of VT Commercial |
$614.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.60
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.60
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.95
|
| Rate for Payer: United Healthcare Commercial |
$614.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,607.74 |
| 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 |
$5,607.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,607.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,440.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,364.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,061.60
|
| 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: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,440.45
|
| Rate for Payer: United Healthcare Commercial |
$7,198.15
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$821.56 |
| Rate for Payer: Aetna of VT Commercial |
$821.56
|
| 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 |
$273.85
|
| 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 |
$372.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.93
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$463.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.87
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare Commercial |
$408.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare VA CCN |
$265.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$7,122.38 |
| Rate for Payer: Aetna of VT Commercial |
$7,122.38
|
| 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 |
$166.05
|
| 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 |
$225.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,829.05
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cigna Commercial |
$279.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,090.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,090.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$675.45
|
| Rate for Payer: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare Commercial |
$247.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare VA CCN |
$161.21
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,533.83 |
| Max. Negotiated Rate |
$5,434.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,434.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,533.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,444.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,862.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,574.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,548.19
|
| Rate for Payer: Cash Price |
$2,860.50
|
| Rate for Payer: Cigna Commercial |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,576.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,574.45
|
| Rate for Payer: Multiplan Commercial |
$5,320.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,862.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare Commercial |
$5,434.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,574.45
|
|
|
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
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$590.30 |
| Rate for Payer: Aetna of VT Commercial |
$410.78
|
| 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 |
$144.65
|
| 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 |
$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 |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| 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 |
$406.41
|
| 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
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$1,245.50 |
| Rate for Payer: Aetna of VT Commercial |
$1,245.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,187.07
|
| 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 |
$1,187.07
|
| 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 |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| 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 |
$1,232.25
|
| 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
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$486.99 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$526.40
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
|
