|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,108.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,108.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$251.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$341.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$622.93
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$424.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.05
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare Commercial |
$375.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare VA CCN |
$244.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$590.30 |
| Rate for Payer: Aetna of VT Commercial |
$410.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$391.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.30
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$243.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.62
|
| Rate for Payer: Multiplan Commercial |
$406.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
9825226501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$149.98 |
| Max. Negotiated Rate |
$1,174.06 |
| Rate for Payer: Aetna of VT Commercial |
$1,174.06
|
| 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 |
$154.48
|
| 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 |
$209.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$908.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$908.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$172.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$908.95
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$261.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$537.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$537.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$330.49
|
| Rate for Payer: Multiplan Commercial |
$1,161.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$212.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$149.98
|
| Rate for Payer: United Healthcare Commercial |
$230.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.98
|
| Rate for Payer: United Healthcare VA CCN |
$149.98
|
|
|
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
|
$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
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$821.56 |
| Rate for Payer: Aetna of VT Commercial |
$821.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$783.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$372.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.93
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$463.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.87
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare Commercial |
$408.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare VA CCN |
$265.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$478.84 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Aetna of VT Commercial |
$614.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.60
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.60
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.95
|
| Rate for Payer: United Healthcare Commercial |
$614.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$457.07 |
| 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 |
$924.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.07
|
| 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 |
$621.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$820.44
|
| 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: Martins Point Health Care Commercial |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$959.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$877.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$464.40
|
| Rate for Payer: United Healthcare Commercial |
$980.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.40
|
| Rate for Payer: United Healthcare VA CCN |
$464.40
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231002
|
|
Hospital Revenue Code
|
960
|
| 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
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$646.85 |
| 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 |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$742.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$699.20
|
| 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: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.90
|
| Rate for Payer: United Healthcare Commercial |
$830.30
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,355.85 |
| Max. Negotiated Rate |
$7,198.15 |
| Rate for Payer: Aetna of VT Commercial |
$7,198.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,355.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,561.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,440.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,137.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,409.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,023.72
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cigna Commercial |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,409.65
|
| Rate for Payer: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,440.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare Commercial |
$7,198.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare VA CCN |
$3,409.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,458.98 |
| Max. Negotiated Rate |
$7,007.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,195.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,900.80
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
9825230001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$613.86 |
| Max. Negotiated Rate |
$1,316.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,316.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$613.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$834.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,178.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,122.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$623.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,101.87
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$1,108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,108.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$623.70
|
| Rate for Payer: Multiplan Commercial |
$1,288.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,178.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$623.70
|
| Rate for Payer: United Healthcare Commercial |
$1,316.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$623.70
|
| Rate for Payer: United Healthcare VA CCN |
$623.70
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,639.32 |
| Max. Negotiated Rate |
$2,104.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,926.85 |
| 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 |
$4,926.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,926.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,658.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,591.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,325.60
|
| 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: Multiplan Commercial |
$6,191.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,658.45
|
| Rate for Payer: United Healthcare Commercial |
$6,324.15
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
9825230001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$258.12 |
| Max. Negotiated Rate |
$1,302.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$449.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$426.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$426.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.12
|
| Rate for Payer: Multiplan Commercial |
$1,288.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.12
|
| Rate for Payer: United Healthcare Commercial |
$397.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.12
|
| Rate for Payer: United Healthcare VA CCN |
$258.12
|
|
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
|
