|
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
|
IP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,458.98 |
| Max. Negotiated Rate |
$7,007.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,195.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,900.80
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$1,813.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,813.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$1,793.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOSCOPY AND TREATMENT
|
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
|
Professional
|
Both
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$4,456.54 |
| Rate for Payer: Aetna of VT Commercial |
$4,456.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.16
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cigna Commercial |
$394.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.92
|
| Rate for Payer: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare Commercial |
$349.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare VA CCN |
$226.92
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$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
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$291.43 |
| 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 |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$291.43
|
| 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 |
$396.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$523.11
|
| 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: Martins Point Health Care Commercial |
$296.10
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare VA CCN |
$296.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,355.85 |
| Max. Negotiated Rate |
$7,198.15 |
| Rate for Payer: Aetna of VT Commercial |
$7,198.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,355.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,561.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,440.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,137.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,409.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,023.72
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cigna Commercial |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,409.65
|
| Rate for Payer: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,440.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare Commercial |
$7,198.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare VA CCN |
$3,409.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9825231001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna of VT Commercial |
$415.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$263.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.42
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.65
|
| Rate for Payer: Multiplan Commercial |
$406.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$415.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare VA CCN |
$196.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
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
|
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
|
$1,929.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$854.35 |
| 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 |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$854.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,728.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,161.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,639.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,562.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$868.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,533.56
|
| 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: Martins Point Health Care Commercial |
$868.05
|
| Rate for Payer: Multiplan Commercial |
$1,793.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,639.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$868.05
|
| Rate for Payer: United Healthcare Commercial |
$1,832.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$868.05
|
| Rate for Payer: United Healthcare VA CCN |
$868.05
|
|
|
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
|
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
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,108.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,108.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$251.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$622.93
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$424.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.05
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare Commercial |
$375.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare VA CCN |
$244.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,906.99 |
| 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 |
$3,906.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,906.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,487.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,434.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,223.20
|
| 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: Multiplan Commercial |
$4,909.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare Commercial |
$5,015.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$692.73 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna of VT Commercial |
$889.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$748.80
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
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
|
$1,779.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
5105231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,316.64 |
| 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 |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,512.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,494.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,423.20
|
| 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: Multiplan Commercial |
$1,654.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,512.15
|
| Rate for Payer: United Healthcare Commercial |
$1,690.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,639.32 |
| Max. Negotiated Rate |
$2,104.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$3,344.52 |
| Rate for Payer: Aetna of VT Commercial |
$3,344.52
|
| 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 |
$191.87
|
| 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 |
$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 |
$1,779.00
|
| Rate for Payer: Cash Price |
$1,779.00
|
| 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 |
$3,308.94
|
| 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
|
$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
|
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
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,079.42 |
| Max. Negotiated Rate |
$4,460.25 |
| Rate for Payer: Aetna of VT Commercial |
$4,460.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,079.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,826.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,990.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,802.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,112.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,732.53
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,756.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,112.75
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,990.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare Commercial |
$4,460.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare VA CCN |
$2,112.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$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
|
|
