|
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
|
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
|
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
|
$1,179.00
|
|
|
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
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$763.78 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Aetna of VT Commercial |
$980.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$825.60
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$825.60
|
| Rate for Payer: Multiplan Commercial |
$959.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$877.20
|
| Rate for Payer: United Healthcare Commercial |
$980.40
|
|
|
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
|
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
|
$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
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$879.84 |
| Rate for Payer: Aetna of VT Commercial |
$879.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$838.56
|
| 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 |
$838.56
|
| 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 |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| 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 |
$870.48
|
| 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
|
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
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$414.55 |
| 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 |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.12
|
| 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: Martins Point Health Care Commercial |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare VA CCN |
$421.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$194.27 |
| Max. Negotiated Rate |
$608.18 |
| Rate for Payer: Aetna of VT Commercial |
$608.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$271.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.48
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$338.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$321.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$321.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.28
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.27
|
| Rate for Payer: United Healthcare Commercial |
$298.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.27
|
| Rate for Payer: United Healthcare VA CCN |
$194.27
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,508.81 |
| 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 |
$3,508.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,508.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,029.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,982.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,792.80
|
| 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: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,029.85
|
| Rate for Payer: United Healthcare Commercial |
$4,503.95
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,234.11 |
| 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 |
$4,234.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,234.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,862.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,805.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,576.80
|
| 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: Multiplan Commercial |
$5,320.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,862.85
|
| Rate for Payer: United Healthcare Commercial |
$5,434.95
|
|
|
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
|
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
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$368.94 |
| 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 |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$368.94
|
| 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 |
$501.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$674.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.24
|
| 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: Martins Point Health Care Commercial |
$374.85
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare VA CCN |
$374.85
|
|
|
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
|
$720.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$318.89 |
| 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 |
$645.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$318.89
|
| 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 |
$433.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$572.40
|
| 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: Martins Point Health Care Commercial |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare VA CCN |
$324.00
|
|
|
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
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$2,011.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,069.72
|
| 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 |
$191.87
|
| 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 |
$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 |
$569.00
|
| Rate for Payer: Cash Price |
$569.00
|
| 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 |
$1,058.34
|
| 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
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$970.08 |
| Rate for Payer: Aetna of VT Commercial |
$970.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$924.57
|
| 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 |
$924.57
|
| 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 |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| 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 |
$959.76
|
| 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
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$5,377.74 |
| Rate for Payer: Aetna of VT Commercial |
$5,377.74
|
| 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 |
$273.85
|
| 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 |
$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 |
$2,860.50
|
| Rate for Payer: Cash Price |
$2,860.50
|
| 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 |
$5,320.53
|
| 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
|
$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
|
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
|
|
