|
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
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,338.07 |
| Max. Negotiated Rate |
$5,015.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,015.05
|
| 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 |
$2,338.07
|
| 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 |
$3,177.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,487.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,275.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,375.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,196.81
|
| Rate for Payer: Cash Price |
$2,639.50
|
| Rate for Payer: Cigna Commercial |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,223.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,375.55
|
| Rate for Payer: Multiplan Commercial |
$4,909.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,487.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare Commercial |
$5,015.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,375.55
|
|
|
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
|
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
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,121.18 |
| Max. Negotiated Rate |
$8,839.75 |
| Rate for Payer: Aetna of VT Commercial |
$8,839.75
|
| 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 |
$4,121.18
|
| 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 |
$5,601.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,909.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,537.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,187.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,397.48
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,444.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,187.25
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,909.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,187.25
|
| Rate for Payer: United Healthcare Commercial |
$8,839.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,187.25
|
| Rate for Payer: United Healthcare VA CCN |
$4,187.25
|
|
|
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
|
$1,779.00
|
|
|
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
|
$1,929.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,427.65 |
| Max. Negotiated Rate |
$1,832.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,832.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,427.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,427.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,639.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,620.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,543.20
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$1,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,543.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,543.20
|
| Rate for Payer: Multiplan Commercial |
$1,793.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,639.65
|
| Rate for Payer: United Healthcare Commercial |
$1,832.55
|
|
|
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
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
5105228501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.95 |
| 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 |
$542.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$267.95
|
| 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 |
$364.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$514.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$490.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$480.98
|
| 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: Martins Point Health Care Commercial |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$562.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$514.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$272.25
|
| Rate for Payer: United Healthcare Commercial |
$574.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.25
|
| Rate for Payer: United Healthcare VA CCN |
$272.25
|
|
|
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
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$531.16 |
| Rate for Payer: Aetna of VT Commercial |
$505.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$481.99
|
| 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 |
$481.99
|
| 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 |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| 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 |
$500.34
|
| 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
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$784.90 |
| Rate for Payer: Aetna of VT Commercial |
$784.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.13
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$245.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$472.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$472.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.26
|
| Rate for Payer: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.22
|
| Rate for Payer: United Healthcare Commercial |
$217.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.22
|
| Rate for Payer: United Healthcare VA CCN |
$141.22
|
|
|
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
|
$1,325.00
|
|
|
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
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6,886.63 |
| Max. Negotiated Rate |
$8,839.75 |
| Rate for Payer: Aetna of VT Commercial |
$8,839.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,886.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,886.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,909.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,816.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,444.00
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,444.00
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,909.25
|
| Rate for Payer: United Healthcare Commercial |
$8,839.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$1,829.05 |
| Rate for Payer: Aetna of VT Commercial |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.28
|
| 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 |
$746.28
|
| 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 |
$416.50
|
| Rate for Payer: Cash Price |
$416.50
|
| 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 |
$774.69
|
| 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
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,099.79 |
| Max. Negotiated Rate |
$4,503.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,503.95
|
| 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 |
$2,099.79
|
| 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 |
$2,854.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,029.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,840.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,133.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,769.09
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cigna Commercial |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,792.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,133.45
|
| Rate for Payer: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,029.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,133.45
|
| Rate for Payer: United Healthcare Commercial |
$4,503.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,133.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,133.45
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,575.84 |
| 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 |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,141.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,881.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,601.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,828.61
|
| 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: Martins Point Health Care Commercial |
$1,601.10
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,601.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231002
|
|
Hospital Revenue Code
|
960
|
| 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
|
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
|
$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
|
$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
|
$7,577.00
|
|
|
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
|
Professional
|
Both
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$6,339.36 |
| Rate for Payer: Aetna of VT Commercial |
$6,339.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,041.95
|
| 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 |
$6,041.95
|
| 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 |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| 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 |
$6,271.92
|
| 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
|
|
